signs of diabetes Archives - University Health News

The Dangers of Yo-Yo Dieting

UHN Staff — Thu, 19 Jan 2023 17:07:29 +0000

What is Yo-Yo Dieting? Like a yo-yo repeatedly moving up and down, “yo-yo dieting,” also known as the yo-yo effect or weight cycling, describes the up-and-down cyclical pattern of losing weight, gaining it back, then dieting to lose it again. The term was coined in the 1980s by Kelly Brownell of Yale University, but its history is as long as dieting. Weight cycling is as common as weight loss diets, which have become increasingly popular (and problematic) in recent decades—and all genders and ages are impacted. Research suggests somewhere between 20 to 35 percent of men and 20 to 55 percent of women have experienced weight cycling.

Avoid the Yo-Yo. Safe and gradual weight loss has documented and well-established health benefits for people with overweight and obesity, such as helping to reduce blood pressure, cholesterol and triglyceride levels, and reducing the risks of diabetes and heart disease. But, repeated and cyclical weight loss-regain-and loss is associated with many potential health issues, some of which are outlined below.

Contributes to Weight Regain. When a person loses muscle mass and fat mass through dieting, there is often a concurrent increase in appetite as the body adapts to conserve energy. This is a protective mechanism that the body uses to protect itself during times of lower caloric intake. Research supports this, as short-term dieters regain about 33 to 65 percent of lost weight in a year, and one in three of those dieters ends up heavier than they were before the diet.
Hard on the Heart. Research shows that weight cycling can lead to potential fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, and cardiac workload during weight gain. The risk factors make the heart work harder, which may not be eased during weight loss and could contribute to injury. Although studies have shown increased risk for cardiovascular disease and death with weight fluctuations, other studies have shown no significant association. However, in those with coronary artery disease, weight fluctuation was associated with higher mortality and higher rate of cardiovascular events independent of traditional cardiovascular risk factors.
Diabetes Danger. Though there is an association between weight cycling and development of type 2 diabetes, the evidence is conflicting and inconclusive. It has been linked with higher-than-normal insulin in the blood, as well as insulin resistance, both of which can be early signs of diabetes. Studies have shown increased risk of diabetes whereas others have noted no significant association.

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The Dangers of Yo-Yo Dieting

Kristen N. Smith, PhD, RDN, LD — Thu, 12 May 2022 17:43:35 +0000

We live in a diet culture, one in which we are constantly exposed to the “next best way to weight loss.” If you’ve toyed with trying one of these trends on for size—Keto, Vegetarian, Atkins, Whole30—or if you’re the type who just dives right in, you likely already know that diets don’t work, at least not for the long term. By their very nature, weight loss diets are usually unsustainable. This is the unfortunate of weight loss diets: weight comes off somewhat quickly in the short-term, the person goes stops following the diet, and the weight is regained (and then some). Repeat. This is yo-yo dieting. This constant fluctuation in weight—over and over again—can potentially be harmful to your health.

The Yo-Yo Effect

Like a yo-yo repeatedly moving up and down, “yo-yo dieting”, also known as the yo-yo effect or weight cycling, describes the up-and-down cyclical pattern of losing weight, gaining it back, then dieting to lose it again. The term was coined in the 1980s by Kelly Brownell of Yale University, but its history is as long as dieting. Weight cycling is as common as weight loss diets, which have become increasingly popular (and problematic) in recent decades—and all genders and ages are impacted. Research suggests somewhere between 20% to 35% of men and 20% to 55% of women have experienced weight cycling. Part of the problem with these figures is the many ways it is defined. Variations occur in the number of cycles of weight loss attempt, across what amount of time, and the amount of weight lost and regained.

Because people with overweight or obesity are more likely to attempt weight loss, they are more exposed to and perhaps prone to weight cycling, compared to someone of normal weight. More and more, research shows that normal weight and even underweight people are affected too, as the desire for losing weight becomes more prevalent. Young girls and teenagers, as well as older women are increasingly preoccupied with weighing less. Excessive weight loss could be a health threat for these groups.

Dangers of Yo-Yo Dieting

Safe and gradual weight loss has documented and well-established health benefits for people with overweight and obesity, such as helping to reduce blood pressure, cholesterol and triglyceride levels, and reducing the risks of diabetes and heart disease. But, repeated and cyclical weight loss-regain-and loss is associated with potential health issues, including the development of disordered eating or eating disorders, type 2 diabetes, hypertension, cancer, bone fractures, and increased mortality. Researchers continue to debate the long-term health consequences of weight cycling.

More Weight Regained. When a person loses muscle mass and fat mass through dieting, there is often a concurrent increase in appetite as the body adapts to conserve energy. This is a protective mechanism that the body uses to protect itself during times of lower caloric intake. Research supports this, as short-term dieters regain about 33% to 65% of lost weight in a year, and one in three of those dieters ends up heavier than they were before the diet.

Hard on the Heart. Research shows that weight cycling can lead to potential fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, and cardiac workload during weight gain. The risk factors make the heart work harder, which may not be eased during weight loss and could contribute to injury. Although studies have shown increased risk for cardiovascular disease and death with weight fluctuations, other studies have shown no significant association. However, in individuals with coronary artery disease, weight fluctuation was associated with higher mortality and higher rate of cardiovascular events independent of traditional cardiovascular risk factors.

Diabetes Danger. Though there is an association between weight cycling and development of type 2 diabetes, the evidence is conflicting and inconclusive. It has been linked with higher-than-normal insulin in the blood, as well as insulin resistance, both of which can be early signs of diabetes. Studies have shown increased risk of diabetes whereas others have noted no significant association.

Why Yo-Yo Dieting Continues

As a society that is increasingly exposed to social media with its pressures of perfection, especially related to physical appearance and weight, it’s no wonder so many people look to diets as a solution. Choosing a diet that is too restrictive to be sustainable may result in rapid weight loss, and short-term feelings of satisfaction. With the weight loss goal achieved, the diet is “done”—until the person returns to their normal eating habits, which inevitably contributes to a weight regain. And so, the cycle begins.

Diets will not lead to long-term success, but lifestyle changes will. Gradual and consistent weight loss that is not overly restrictive can help people keep weight off and maintain a healthy weight over time.

Lifestyle Habits for Healthy Weight

Eat more whole, healthy, mostly plant-based foods, such as fruits, vegetables, whole grains, nuts and seeds, and legumes.
Limit processed foods, such as packaged salty and sugary snacks made from refined flour with added sugars, and artificial ingredients.
Get physically active doing what you love, whether walking, gardening, dancing, or working out at the gym with a friend.
Cook at home so you control the ingredients you’re eating. Dine out less, especially fast food.

Yo-yo dieting is a vicious cycle that can be hard to escape. It can be frustrating, defeating, and can threaten long-term health. Reframing the practice of short-term dieting for quick weight loss with healthy lifestyle changes that bring about gradual and sustainable weight loss and maintenance can help break free from this cycle.

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4. Skin Conditions: From Acne to Lupus

Jim Brown, PhD — Fri, 06 Dec 2019 18:40:07 +0000

There are hundreds of noncancerous skin growths and conditions, and this chapter describes, in alphabetical order, 18 of the most common problems. An additional 18 are covered in Chapter 5. Most do not require medical attention, those that do are often unreported, but all of them should be monitored in case changes occur.

The exact cause of many noncancerous skin conditions is unknown (rosacea, for example), but scientists have discovered the origins of several familiar abnormalities.

Warts are caused by viruses, athlete’s foot by a fungal infection, and boils by bacteria. Rashes can be triggered by allergens, Lupus is an autoimmune disease, and seborrheic keratosis has a genetic link. Stress and environmental irritants can trigger or make skin problems worse.

Cold sores, measles, and poison ivy are contagious, but psoriasis, hives, and eczema are not.

At-home treatment is often possible with over-the-counter or prescription medications. When medical procedures are required to remove a growth, it can be done with an electric needle, a scalpel, a laser, or by freezing with liquid nitrogen. Almost all procedures can be performed in the office of a dermatologist.

The take-away message is that being knowledgeable about skin growths, conditions, and abnormalities—noncancerous in this chapter and in the following chapters—enables you to make informed decisions about your own skin health and that of your family.

Acne: Not Just for Teens

The most common skin condition in the U.S. is acne, which affects as many as 50 million people annually, and it’s not limited to teenagers.

According to American Academy of Dermatology (AAD), most cases of acne are seen in teenagers, but adult men and women can also get the condition (even in middle age).

Acne is inflammatory, chronic, and develops when hair follicles get plugged with oil. It can be affected by stress, humid climates, oil-based makeup, and hormonal changes.

Dermatologists may grade acne on a 1-4 scale—1 is mild, 4 is severe—but there is no universally accepted grading system. Once diagnosed, mild cases can be controlled with over-the-counter topical medications that either kill the bacteria or reduce the production of oil. The medicine may contain a retinoid, benzoyl peroxide, antibiotic, or salicylic acid. Isotretinoin, says the AAD, is the only treatment that is effective in all cases of acne.

More serious cases are treated with lasers, other light therapies, chemical peels, or a “drainage and extraction” procedure to remove a large cyst.

Treatment is individual in nature. What works for one person may not work for another. Without treatment, acne can cause permanent scars. Treatment should continue even when the skin clears.

Athlete’s Foot

Athlete’s foot is an infection caused by a fungus, according to the American College of Foot and Ankle Surgeons. It develops because feet spend a lot of time in the perfect breeding environment of warm, dark, humid shoes.

The symptoms are redness, small blisters, itching, and peeling, especially between the toes. Once the infection develops, it can be challenging to cure. It’s rare, but the infection can spread to other parts of the body, including the toenails. Treatment options include over-the-counter antifungal powders, sprays, and creams, and prescription antibiotic medications. If things don’t get better within two weeks, see your doctor.

Prevent symptoms by keeping your feet clean and dry. Wear wicking acrylic or cotton socks. It’s the same infection that causes Jock itch, so men should wear socks before putting on underwear. Change shoes, socks, or stockings often, and use foot powder daily. Avoid walking barefoot, especially in humid public places, such as locker rooms.

Blisters

Blisters are small pockets filled with fluid that develop on the upper layer of skin, which is trying to protect itself. They are usually caused by friction.

Treatment starts with covering the blister with a bandage. If the blister is in an area of the foot that can be protected, use padding to protect it. Cut the padding into a donut shape with a hole in the middle, then place it around the blister. Cover the padding with a bandage. Avoid popping or draining a blister if possible, as it could lead to infection.

If a blister is large and painful, sterilize a small needle with rubbing alcohol, pierce the edge of the blister and allow some of the fluid to drain. Do not remove the skin.

Here are some tips from the AAD for protecting your feet from blisters:

Wear nylon or moisture-wicking socks.
Try wearing two pairs of socks.
Make sure your shoes fit properly—not too tight or too loose.
Use powder or petroleum jelly to reduce friction when your skin rubs together or against shoes.
Stop an activity immediately if you experience pain or discomfort, or your skin suddenly turns bright red.

Boils

A boil is a skin infection that develops around a hair follicle. Common sites are the face, neck, armpits, buttocks, groin, and thighs. Boils begin as a red, elevated, warm, and painful bump on the skin, which is often caused by an infected hair follicle. A foreign object (like a splinter) embedded in the skin, a plugged sweat gland, or blocked oil duct also can trigger boils.

A staphylococcus infection is often the main culprit. Individuals with diabetes, immune deficiencies, poor nutrition, and poor hygiene are at a greater risk for boils than the general population.

As boils grow, the area may get bigger, softer, and even more painful. Within a week, the area turns white as pus makes its way to the surface. Sometimes it drains through the skin. At other times, it has to be lanced and drained by a physician. Several boils can develop at the same time because the infection spreads to the surrounding area, or is transported to some other part of the body.

Warm Compresses to Ease Pain

Warm compresses or soaking the boil in warm water for 20 minutes, three or four times a day can ease the pain. The increase in temperature draws the pus closer to the skin’s surface and allows it to eventually drain out.

Applying antibiotic creams on the area before the boil comes to a head will not work, because the medication does not penetrate the skin. “Coming to a head” means the top of the area breaks and the pus drains out, but the process could take as long as 10 days.

Lancing Could Spread Infection

Do not lance the boil yourself, as doing so could allow the infection to spread. If and when the boil does break, keep the area clean by gently washing it with an antibacterial soap two or three times a day. Apply a medicated ointment and cover the area with a bandage.

See a doctor if the infected area gets worse, if you develop a fever, if the boil does not drain, if additional boils appear, if the boil limits your normal activities, or if you have diabetes. Do not take chances. If in doubt, call your family doctor or a dermatologist.

Calluses/Corns

Both corns and calluses involve a thick outer layer of skin, and both can be caused by pressure or toes rubbing together. They may also result from foot deformities or misshapen toes associated with rheumatoid arthritis.

The difference is that corns (and there are five types of them) have a core and normally develop on a knobby part of a toe, while calluses are evenly distributed on the soles of the feet. Although some calluses may protect a part of the foot, both corns and calluses can be big enough to cause pain and difficulty in walking.

Treat Only if Painful

When calluses and corns are painful, the goal of treatment is to reduce or eliminate the pressure or friction that causes them. Wear shoes that fit properly, use pads that cushion the area, and use an over-the-counter product (salicylic acid) that softens the tissue, making it possible to remove the dead skin. If you have diabetes, peripheral artery disease, or peripheral neuropathy, get medical attention.

Otherwise, neither corns nor calluses need treatment unless they cause pain. If possible, avoid the contact that causes the friction. If hands are affected, wear protective gloves. You can also relieve the pressure by using a doughnut-shaped pad on the foot. In rare cases, surgery is needed to remove a corn or callus.

You should not cut a callus or corn, especially if you have diabetes or any other condition that affects circulation, but you can gradually wear down the area with a pumice stone.

Prevention

Prevention is always better than treatment. Steps you can take to reduce your risk include not wearing tight, high-heeled, or loose-fitting shoes, or socks that do not fit. Walking barefoot can also cause calluses and should be avoided when doing so is the cause. See “Tips for Managing Corns and Calluses” for AAD suggestions.

Cellulitis

Cellulitis is a skin infection, most commonly caused by streptococcal bacteria. Symptoms include pain, warmth, redness and tenderness. It is caused or associated with an injury to the skin that results in a small break, allowing the bacteria to enter. The majority of cases involve just one side of the body, most likely on the lower legs. It can also affect the skin around the eyes. In severe cases, the symptoms might include fever or chills, nausea, increased pain, headache, rapid heart rate, and low blood pressure.

At higher risk for cellulitis are those who have sustained an injury, have other skin conditions (such as eczema, athlete’s foot, or shingles), are obese, or have a weakened immune system.

Treatment with antibiotics usually resolves the problem within two or three days, but the symptoms may get temporarily worse before they subside. Rest, elevation, and over-the-counter pain relievers can help ease the discomfort. If an abscess develops, it has to be drained.

Washing wounds daily with soap and water, applying a protective cream or ointment, covering wounds with bandages, and watching for signs of increased infection are sound prevention methods.

Cold Sores

Cold sores (fever blisters) are caused by the herpes simplex virus (HSV-1), the oral form of the virus that never leaves the body once it has been contracted.

HSV-1 infects more than half of all people in the United States between the ages of 14 and 49, and up to 67 percent of people in the world. It is one of the world’s most contagious conditions, easily transmitted as a result of close contact.

The symptoms include fluid-filled blisters on the mouth that eventually break and ooze, sore throat, swollen glands, fever, and headaches. Outbreaks can occur in some people several times in one year.

The news is not all bad. Some fortunate people infected with the same virus never have an episode. It remains dormant throughout life. For those who experience cold sores, the condition is self-limiting—the unsightly symptoms run their course within two weeks.

Over-the-counter creams that contain acyclovir or penciclovir can shorten the duration of an episode. Prescription antiviral medications like acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) are effective for more serious cases. Reduce the chance of infecting others by:

Not kissing people when symptomatic
Avoiding close contact with those who have a weakened immune system
Not sharing personal items that come into contact with the face
Not sharing food or drinks
Not touching a cold sore
Washing your hands frequently

Cysts

Sebaceous, keratin, epithelial, and epidermoid are terms used to describe small, fairly common cysts that develop just below the surface of the skin. The U.S. National Library of Medicine refers to them as epidermoid cysts.

Epidermal cysts are sacs beneath the skin’s surface filled with keratin and fatty material. They often develop at the site of a damaged hair follicle on the face, neck, trunk, genital area, and behind the ears. In some cases, there is an opening in the center through which the foul-smelling fatty content of the cyst can escape.

Cysts can move around (under the skin) within a small area. They can become tender, inflamed, and perhaps larger than when you first noticed them. Typical epidermal cysts range in size from one-quarter inch to two inches. When inflammation is involved, cysts are likely to be tender and red, and the temperature of the skin on top of the growth may rise.

Risk factors for cysts are age (most people get them during their 30s or 40s), gender (men are twice as likely to get them as women), a history of acne, an injury to the skin (any type of crushing or traumatic injury), and long-term sun exposure.

Most Require No Treatment

Epidermal cysts are not dangerous, and most require no treatment. If you think one has become inflamed, or if you have one that is large or painful enough to interfere with daily activities, your doctor can diagnose the condition with an examination. In some cases, a biopsy can rule out more serious skin conditions.

A warm compress might help drain the cyst—do not force the drainage—or your doctor might inject the area with a steroid to reduce inflammation. On rare occasions, surgery is required to remove it. Cysts may recur. You cannot prevent these growths, but avoiding excessive sun exposure and using skin products that do not contain oils might help.

Dermatitis

Coming into contact with foreign substances triggers most rashes and skin irritations. The one that is most likely to cause problems in older adults is dermatitis. The two most common forms are allergic contact dermatitis and irritant contact dermatitis.

A third form is called atopic dermatitis (atopic eczema), a condition passed from parents to children that can develop at any time during a person’s life. It is primarily a problem for infants and children.

Eczema

Eczema is not one condition, it’s at least seven. In one form or another, eczema affects more than 30 percent of the U.S. population.

Up to 18 million Americans have symptoms of eczema. Ninety percent of those who get the form known as atopic dermatitis (AD) do so before the age of five, and half of them continue to have symptoms for a lifetime. It’s manageable but not curable. The condition is not contagious, but it runs in families. The symptoms are different in adults than they are in children. Its cause is a mystery. The AD variety of eczema comes with lots of baggage. Knowing what to look for and what to do about it won’t cure the skin disorder, but it can make living with AD less painful and less stressful.

Symptoms (in adults):

Dry, scaly skin
Itchy skin
Thickened or cracked skin
Rash that is red, swollen, and sore
Rash that gets worse with scratching
Rash or bumps that may leak clear fluid
Rash that becomes infected

The most common places for the rash to appear are the cheeks, wrists, hands, behind the knees, in the creases of elbows, and on the buttocks. For those who have had AD flares (flare-ups) in childhood, their experience of symptoms tends to be much milder in adulthood.

Contributing Factors of AD. The exact cause of AD is unknown, but there are plenty of contributing factors. You are more likely to have AD if a family member has it—or allergies, or hay fever, or asthma. The connection has to do with a genetic variation that alters the skin’s ability to protect itself. The crossed signals also cause the body to overreact to outside forces—triggers—including:

Scratchy clothes
Cleaning products
Soaps
Dust
Animal dander and saliva
Excessive heat or cold
Perspiration
Stress

Foods (nuts, dairy products, eggs, fruit juices, soy products, wheat) do not cause AD, according to the AAD, but food allergies may make it worse.

The list of triggers is long, but not every person’s body responds to every one. Part of prevention is knowing which substances or events cause your particular symptoms and avoiding them. Diagnosis by a family doctor or dermatologist is relatively straightforward. It consists of taking a person’s medical history, observation of symptoms, and may require a blood or patch test to determine the trigger.

Treatment of Choice. Corticosteroids are the treatment of choice, but the U.S. Food and Drug Administration (FDA) has approved newer and effective gels, foams, and oils. In March 2017, the FDA approved dupilumab (Duprixent) in injection form to treat adults with moderate-to-severe AD. The medication is intended for patients whose eczema is not controlled by topical drugs or for whom topical therapies are not advisable. If AD is accompanied by a skin infection, antibiotic, antiviral, and antifungal drugs may be recommended. Antihistamines can produce drowsiness when taken at bedtime to reduce itching and scratching. Light therapy (phototherapy) uses ultraviolet (UV) rays to treat moderate cases of dermatitis.

Prevention. Among the home measures you can take is to apply an over-the-counter moisturizer/body lotion every day and within three minutes of bathing or showering, to capture moisture.

Here are other preventive measures:

Take lukewarm baths (hot water can trigger a flare).
Wear soft fabrics, not scratchy ones.
Use mild or non-soap products.
Use a humdifier when the weather is dry or cold.

Allergic Contact Dermatitis

This rash appears when the immune system overreacts to allergens like poison ivy, poison oak, poison sumac, cosmetics, latex, nickel, and hair dyes. Even the fragrances in certain soaps, shampoos, and perfumes can cause a reaction.

Antibodies from your immune system come into contact with the allergens and set off “mediators,” such as histamine, which cause the symptoms. Allergic contact dermatitis may appear almost immediately or a day or two after exposure. Symptoms include reddish skin or a rash, an itching or burning sensation, swelling, and blisters that ooze, break, and leave crusts or scales.

Drugs may cause problems themselves. Neomycin, a commonly sold over-the-counter topical antibiotic, and formaldehyde (a chemical found in building materials and some household products) are two examples that cause allergic contact dermatitis.

The American Contact Dermatitis Society selected isobornyl acrylate as the 2019 Contact Allergen of the Year. It is an acrylic molecule used as an adhesive. Among other applications, isobornyl acrylate is often used in medical devices. The selection was made based on multiple case reports of diabetes patients developing contact allergies to their diabetes devices, such as insulin pumps. Routine testing does not identify the substance, so it is very important that the clinician be aware of its danger.

Other Contact Allergens of the Year over this decade include:

2010: Neomycin (found in antibacterial products, tooth paste, creams, eye drops, pet food, deodorants, soaps, cosmetics, vaccines)
2011: Dimethyl fumarate (medications for multiple sclerosis, psoriasis, other medications)
2012: Acrylate (synthetic flavoring, fragrances, latex paints, dirt-release agents, paper coatings, floor polishes, sealants, shoe polishes, adhesives, acrylic nails, hearing aids, dental fillings)
2013: Methylisothiazolinone (laundry detergents, cream cleansers, window cleaners, countertop sprays, room sprays, stain removers, carpet shampoos, air fresheners)
2014: Benzophenones (nail polish, lip balm, sunscreen, soap, makeup products)
2015: Formaldehyde (mattresses, sheets, furniture, air fresheners, clothing)
2016: Cobalt (glass, pottery, crayons, costume jewelry, zippers, buckles, utensils, tools, dental plates)
2017: Alkyl glucoside (shampoos, skin cleansers, wipes, sunscreens, deodorants, moisturizers, shower gels, fragrances)
2018: Propylene glycol (soft drinks, frozen meals, spices, cake mixes, salad mixes, soups, soft drinks, artificial sweeteners)
2019: Isobornyl acrylate (adhesives, medical devices, nail polish)

Irritant Contact Dermatitis

This form of dermatitis is caused by a foreign substance that comes into direct contact with your skin and damages the area. Detergents and solvents are examples. They can wear down the skin’s protective surface. The longer the substance stays on the skin, the more serious the damage, and it could take up to four weeks for the area to return to normal. Symptoms and signs include pain, redness, scales, and even cracks in the skin.

Treatment. Treat itching and other symptoms of most rashes at home with cortisone-based creams to reduce inflammation. Other options are calamine lotions, oral antihistamines, and oatmeal baths. Over-the-counter drugs like Benadryl and Ben-Allergin may also help. Try to resist scratching, which will further inflame the rash.

For irritant contact dermatitis, wash the area with soap and cool water immediately after contact to get rid of the foreign substance. Treat any blisters that may form with cold, moist compresses 30 minutes at a time, three times a day. Seek medical help if the rash does not improve within two or three days, or if it continues to spread.

Diabetes and Skin

Sometimes a skin disorder is the first sign that diabetes is present. Diabetes and skin issues are directly linked. The warm, high-sugar content of the blood is a perfect environment for the growth and development of skin-related bacterial and fungal infections. Anyone can get these skin conditions, but people with diabetes are more susceptible.

A common symptom of many diabetes-related skin diseases is itching. It can be caused by a variety of issues, including dry skin, yeast infections, or diminished blood flow to an area of the skin. Lower legs are affected more often than other regions of the body. Lotions and moisturizers can limit itching by keeping the skin soft and moist, but excessive amounts applied to certain areas create an environment conducive to infections.

The AAD has identified several skin-related problems associated with diabetes (see “12 Skin-Related Warning Signs of Diabetes”).

“If you have diabetes, try to avoid trauma and follow up with a podiatrist if your feet are involved or with a dermatologist for any skin conditions,” says UCLA’s Dr. Lorraine Young. (medical editor of this report).

Bacterial Infections

Styes, boils, carbuncles (a cluster of boils), and nail infections are examples of bacterial infections that can occur in people with diabetes. The symptoms are hot, swollen, red, and painful spots, depending on the condition (styes on the eyelids; boils around hair follicles; carbuncles deep in the skin; nail infections on hands or feet). The most common type of bacterial infection is staphylococcus, or “staph,” for short.

Bacterial infections are treatable with antibiotics and perhaps preventable by controlling blood sugar levels. Nevertheless, people with diabetes are affected more than those without the disease. Only a doctor can diagnose the infection and prescribe medications, either in pill or cream form.

Fungal Infections

Athlete’s foot, jock itch, ringworm, and some vaginal infections are fungal infections that affect the general population, but which present special problems for people with diabetes. The cause is often a yeast-like fungus. It causes an itchy, red area surrounded by small blisters and scales, usually in warm, moist folds of the skin, such as the mouth, vagina, breasts, fingers, toes, nails, and rectum. The fungus can move through the bloodstream and affect other areas of the body, too.

Diabetic Dermopathy

This condition is caused by changes in small blood vessels that result in light brown, scaly, oval, or circular patches of skin, often on the front of the legs. The patches do not itch, hurt, or drain and usually do not require treatment.

Necrobiosis Lipoidica (NL)

This rare condition is caused by a change in the blood vessels, and consists of oval plaques, usually on the lower legs. It is similar to diabetic dermopathy, but the spots are larger, deeper, and fewer in number. NL may begin as small red or raised spots, which develop a shiny appearance surrounded by a violet-colored border. The spots often turn brown and fade, but often leave a permanent discoloration. NL can be painful and itchy. Adult women are more susceptible, and people with diabetes account for two-thirds of all cases. If the plaques break open, see a dermatologist for treatment.

Diabetic Blisters

People rarely develop diabetic blisters on their fingers, hands, toes, feet, legs, or forearms, but it can happen. They resemble blisters caused by burns, but are not painful. Diabetic blisters heal in two to three weeks without treatment. Those who develop the blisters often have diabetic neuropathy, a nerve disorder. The only way to guard against the incidence of diabetic blisters is to control blood sugar.

Eruptive Xanthomas (EX)

This condition develops when diabetes has gotten out of control. The symptoms are small, firm, yellow-red bumps on the skin. A red circle surrounds the bumps, and the area may itch. EX often appear on the backs of hands, feet, arms, legs, and buttocks. A person at risk has type 1 or type 2 diabetes and elevated blood lipids. However, the bumps disappear once the person’s blood sugar level returns to acceptable levels.

Prevention

The AAD suggests these measures to prevent or reduce the risk of diabetes-related skin diseases:

Keep skin clean and dry by using cornstarch-based or talcum powder where skin touches skin.
Avoid hot baths and showers, and do not put lotion between your toes. Warm, moist surfaces are breeding grounds for infections.
Prevent dry skin by using moisturizers, especially in cold, windy weather.
Treat cuts immediately. Wash them with soap and water, but avoid products that are too harsh, such as alcohol and iodine.
Use antibiotic cream only if advised to do so by your doctor.
Keep your home more humid than normal during cold, dry months.
Bathe less, if practical.
Use mild shampoos, and avoid feminine hygiene sprays.

Folliculitis

Folliculitis is a common skin condition in which hair follicles become inflamed. Follicles damaged by friction, blockage, or shaving can become infected with the staphylococcus (staph) bacteria. Folliculitis is easy to treat, but it may recur and the infection can spread to other areas of the body. Symptoms include a rash, itching, or pimples on the neck, groin, or genital area. Your doctor may be able to diagnose folliculitis with a visual exam. Lab tests show the type of disease agent that has caused the infection. Hot, wet compresses can help drain the area, and treatment may include oral or topical antibiotics. If self-care does not relieve symptoms within two or three days, contact a medical professional.

Granulomas

Granulomas are small nodules (bumps) that can develop all over the body and can range in severity from benign to malignant. They are relatively common in adults.

The two types that can affect the skin are called pyogenic granuloma (caused by an injury to the skin) and granuloma annulare (the most common form).

The pyogenic variety, most often found on the arms, hands, and face, might resolve without treatment, but most of the time they have to be removed surgically.

Granuloma annulare is more common in children and young adults. It may or may not disappear on its own, but can be treated with steroid creams or injections. In some cases, treatment involves a combination of medication followed by exposure to UV light.

Hives

This condition is produced by blood plasma leaking through small gaps between the cells lining the small blood vessels in the skin. The condition appears as red, raised areas in irregularly shaped sizes ranging from small to several inches across.

These welts, which have a red border, can develop anywhere on the body, including the arms, legs, and trunk, either alone or in groups. When the condition lasts longer than six weeks, it is classified as chronic hives. In both cases, flare-ups come and go, only to appear somewhere else on the body.

The person most likely to suffer from hives has had a previous episode, tends to have allergic reactions in addition to those resulting in hives, has a family history of hives, or has a non-skin-related disorder such as lupus, lymphoma, or thyroid disease.

Acute Reactions

Acute hives can last from a few hours to several weeks. It is often caused by the body’s reaction to certain foods (eggs, tomatoes, chocolate, nuts, milk, and shellfish, for example), medications (aspirin, penicillin, sulfa drugs, sedatives, antacids, laxatives, codeine, and others), stings (bees, wasps), or infections (hepatitis, strep throat, mononucleosis, colds). Physical factors, such as heat, cold, sunlight, water, pressure on the skin, exercise, and emotional stress, can also trigger episodes in 20 percent of cases.

Chronic Reactions

Not only do chronic hives last longer, but their cause is harder to detect. There is no specific test to identify the condition. In more than 80 percent of chronic cases, the cause is unknown, despite reviews of a patient’s medical history, physical examinations, blood work, skin tests, and biopsies. In about one-half of those cases, the body’s immune system triggers the release of histamines, which cause the fluid to leak from blood vessels and produce swelling.

In a related condition called angioedema, the swelling occurs underneath the skin rather than on top. Affected areas include the lips, eyes, hands, feet, and sometimes the genitals. The swelling caused by angioedema also may affect the throat, tongue, or lungs, and make breathing difficult. This life-threatening situation requires immediate medical attention.

Relieve the Symptoms

The goal is to relieve the symptoms, and that may be done with cool compresses or showers, damp cloths, loose-fitting clothes, minimizing vigorous physical activity, and avoiding uncomfortably warm environments.

Over-the-counter antihistamines like Allegra, Benadryl, Chlor-Trimeton, Claritin, Tavist, Xyal and Zyrtec offset the effects of the histamine produced by the body, as can prescription drugs, such as hydroxyzine (Atarax, Vistaril), and desloratadine (Clarinex). These medications may be taken in combination with drugs known as histamine-2 (H2) blockers, like Zantac and Tagamet.

The corticosteroid prednisone (Deltasone, Rayos, Sterapred), when taken orally, might control hives, but it is seldom recommended because of its side effects, such as fluid retention, increased blood pressure, and elevated pressure in the eyes.

Before taking any over-the-counter or prescription medications, let your doctor know which other drugs you take, including supplements. Doing so could prevent drug interactions and complications. Any type of drug therapy should be designed for your specific needs.

Avoid the Problem

Avoiding the substances and environments that causes hives is the best way to prevent them, but it is not always that easy. If you think foods are the problem, keep a log to detect suspect items or ingredients. Foods that can be associated with hives include:

Eggs
Milk
Nuts
Fish
Berries
Chocolate
Tomatoes

Heat Rash

Heat rash is a hot weather-related condition that affects all ages. The condition is also known as prickly heat, miliaria, and summer rash. Regardless of what it’s called, the condition is an inflammation of the skin caused by blocked sweat glands. It is uncomfortable and itchy, but can be treated at home and usually goes away within a few days, with or without treatment.

Aging, Overweight, Humidity

Heat rash can affect just about anyone of any age. Those at highest risk are people who live in hot and humid climates, older adults, overweight individuals, exercisers, those who sweat a lot, and babies. It is often associated with babies because their sweat glands are not fully developed.

Blocked Sweat Glands

Sweat glands are located in the second layer of skin (the dermis). When sweat ducts are blocked, perspiration cannot get to the surface and evaporate. Instead, it gets trapped under the skin, where it causes mild inflammation resulting in a rash. The combination of sweating heavily when exercising while wearing clothes that don’t allow the sweat to evaporate can also trigger the rash. Heat rash can even happen during the winter if people wear too much clothing or sit close enough to a fire or heater to sweat.

Symptoms Indicate Type

Four types of heat rash have medical terms most of us wouldn’t recognize or use. They are easier to remember by how the rash looks—red, white, clear, or deep.

Red heat rash is the most common form. It’s called “prickly heat” because it itches and burns.
A yellow or white rash might be a sign of infection and is a reason to have it checked by a doctor.
Clear heat rash looks like small, clear beads of sweat on top of the skin. It is the mildest form and is not likely to cause any discomfort or itching.
Deep heat rash is caused by repeated episodes and chronically inflamed sweat glands. Deeper layers of the skin are affected and the rash may appear as large, firm bumps.

The most common places for the rash to develop are creases in the skin, such as the armpits, neck, and groin, where skin rubs against adjacent skin. Wearing tight clothes can prevent sweat from evaporating, especially around the waist, chest, or groin. Bandages and heavy creams or lotions can also block sweat glands.

Treatment and Prevention

Heat rash is uncomfortable but treatable. The first step is to stay cool. The rash may disappear simply by cooling the skin. If that doesn’t work, here are a few other suggestions:

Avoid activities that cause sweating.
Stay in the shade when outdoors and in air-conditioned spaces when inside.
Wear loose-fitting, loose-woven, thin, moisture-wicking, quick-drying clothes.
Take cool showers.
Use mild, antibacterial soaps.
Use over-the-counter, anti-itch medications that contain calamine, menthol, or camphor.
Be careful about using oil-based skin products that can clog pores.

When to Call Your Doctor

Although heat rash can be uncomfortable, it is usually mild and goes away quickly. Common sense and home remedies are enough to keep the doctor away in most cases.

But if the rash doesn’t go away in a few days, see your doctor. If the area is painful, red, swollen, or warm, or if the lesions are draining, it is likely to be infected and in need of medical attention. The same goes for swollen nodes in the armpits, neck, or groin, and if you have a fever or chills.

Impetigo

This condition is caused by a bacterial infection that produces crusty skin lesions that itch first and ooze later. A doctor often can diagnose impetigo simply by looking at it.

Antibacterial creams are an effective treatment for mild infections, but more severe cases require oral antibiotics. The lesions seldom leave scars, even though they are slow to heal. Prevent the spread of impetigo by using clean washcloths and towels, and do not share towels, clothing, razors, or any similar items with friends or family members.

Lichen Simplex

This very itchy patch of skin develops after repetitive scratching and rubbing. The itch could be there because of any one of several skin conditions, including psoriasis, eczema, a fungal infection, or an insect bite. Other symptoms are a leathery or scaly texture of the affected areas, or a raised patch of skin that is red or darker than the rest of your skin.

Women are more likely to develop lichen simplex than men. It usually occurs between the ages of 30 and 50.

The condition is not contagious and usually affects just one side of the body, but the itching is so bad it can interrupt sleep and affect quality of life. The areas most often affected are the head, back of the scalp, neck, lower legs, wrists, forearms, ankles, and genitals. Anxiety and stress can trigger the itching.

Treatment options are topical steroids, steroid injections, moisturizers, cooling creams that contain menthol, and antihistamine or antidepressant medications to help you sleep.

Lupus

Lupus is a chronic disease in which the body’s immune system attacks its own healthy cells, tissues, and organs by mistake. There are four types of lupus, but the most common and serious form is systemic lupus erythematosus, which can affect many parts of the body, including the skin. Other potential targets are the joints, lungs, kidneys, and blood.

Lupus can affect anyone at any age, but women get it more often than men. It is typically diagnosed between ages 15 and 45 and is more common in Asians and African Americans than in other ethnic groups.

Butterfly Rash

A “butterfly rash” is at the top of the list of symptoms. It is a reddish eruption across the bridge of the nose and cheeks. Other symptoms of lupus include fever, fatigue, and weight loss; a rash in an area exposed to sunlight; raised, scaly patches; arthritis involving multiple joints for several weeks; mouth or nose ulcers; kidney problems (detected with blood tests); anemia, low blood cell count, or low platelet counts; and seizures.

Because the symptoms vary from person to person, lupus is difficult to diagnose. There is no single test that can absolutely confirm that a person has lupus. Instead, your physician (or a rheumatologist) will compile a comprehensive medical history, conduct a physical exam, and put you through a battery of laboratory tests.

Treatments

If and when lupus is diagnosed, treatment includes rest, exercise, physical therapy, and medications—nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, antimalarial drugs, and medications that suppress the immune system. It is important for a person who has lupus to avoid exposure to sunlight and UV rays emitted indoors by fluorescent and halogen lights.

In Chapter 5

The next chapter covers skin conditions from Lyme disease to wrinkles and what you can do about them.

The post 4. Skin Conditions: From Acne to Lupus appeared first on University Health News.

4. Noncancerous Skin Conditions

Jim Brown, PhD — Wed, 07 Nov 2018 16:52:22 +0000

Among the infinite number of conditions that could do harm to your skin are the 30+ discussed in this chapter. They range (alphabetically) from athlete’s foot to wrinkles.

Athlete’s Foot

Bacterial and fungal infections (including athlete’s foot) develop because feet spend a lot of time in the perfect breeding ground of warm, dark, humid shoes.

You’ll recognize the symptoms of redness, small blisters, itching, and peeling. Once these infections develop, they are hard to cure. Treatment possibilities are over-the-counter (OTC) antifungal products and prescription antibiotic medications. Prevent symptoms by keeping your feet clean and dry. Wear wicking acrylic or cotton socks. Change shoes, socks, or stockings often, and use foot powder daily. If things don’t get better within two weeks, see your doctor.

Blisters

Blisters are usually caused by friction. They are small pockets filled with fluid that develop on the upper layer of skin, which is trying to protect itself.

Treatment begins by covering the blister with a bandage. If the blister is in an area of the foot that can be protected, use padding to protect it. Cut the padding into a donut shape with a hole in the middle, then place it around the blister. Cover the padding with a bandage. Avoid popping or draining a blister, if possible as it could lead to infection.

If, however, a blister is large and painful, sterilize a small needle with rubbing alcohol, pierce the edge of the blister and allow some of the fluid to drain. Do not remove the skin.

Here are some tips from the American Academy of Dermatology (AAD) for protecting your feet from blisters.

Wear nylon or moisture-wicking socks.
Try wearing two pairs of socks.
Make sure your shoes fit properly—not too tight or too loose.
Use powder or petroleum jelly to reduce friction when your skin rubs together or against shoes.
Stop an activity immediately if you experience pain or discomfort or your skin turns red.

Boils

Common sites for boils are the face, neck, armpits, buttocks, groin, and thighs. Boils begin as a red, elevated, warm, and painful bump on the skin, which is often caused by an infected hair follicle. A foreign object imbedded in the skin, a plugged sweat gland, or blocked oil duct also can trigger boils.

Bacteria can cause boils as well, and a staphylococcus infection is often the main culprit. Individuals with diabetes, immune deficiencies, poor nutrition, and poor hygiene are at a greater risk for boils than the general population.

Treat With Heat

Self-care includes applying warm compresses or soaking the boil in warm water for 20 minutes, three or four times a day. The increase in temperature draws the pus closer to the skin’s surface, and it may make the area less painful. Applying antibiotic creams on the area before the boil comes to a head will not work, because the medicine does not penetrate the skin. “Coming to a head” means the top of the area breaks and the pus drains out, but the process could take as long as 10 days.

Do Not Lance It Yourself

See a doctor if the infected area seems to get worse, if you develop a fever, if the boil does not drain, if additional boils appear, if the boil limits your normal activities, or if you have diabetes. Do not take chances. If in doubt, call your family doctor or a dermatologist.

Calluses and Corns

Both corns and calluses involve a thick outer layer of skin, and both can be caused by pressure or toes rubbing together. They may also result from foot deformities causes by rheumatoid arthritis or misshapen toes.

Treatment

When calluses and corns are painful, the goal of treatment is to reduce or eliminate the pressure or friction that causes them. Wear shoes that fit properly, use pads that cushion the area, and use a product (salicylic acid) that softens the tissue, making it possible to remove the dead skin. If you have diabetes, peripheral artery disease, or peripheral neuropathy, get medical attention.

Otherwise, neither corns nor calluses need treatment unless they cause pain. If possible, avoid the contact that causes the friction. If hands are affected, wear protective gloves. You can also relieve the pressure by using a doughnut-shaped pad on the foot. An over-the-counter salicylic acid product softens the area and enables you to remove the dead skin. In rare cases, surgery is needed to remove a corn or callus.

You should not cut a callus or corn, especially if you have diabetes or any other condition that affects circulation, but you can gradually wear down the area with a pumice stone.

Prevention

Cellulitis

The symptoms of cellulitis are pain, warmth, redness, and tenderness. It is caused or associated with an injury to the skin that results in a small break. The majority of cases involve just one side of the body, most likely on the lower legs. In severe cases, the symptoms might include fever or chills, nausea, increased pain, headache, rapid heart rate, and low blood pressure.

At higher risk for cellulitis are those who have sustained an injury, have other skin conditions (such as eczema, athlete’s foot, or shingles), are obese, or have a weakened immune system.

Washing wounds daily with soap and water, applying a protective cream or ointment, covering wounds with bandages, and watching for signs of infection are sound prevention methods.

Cysts

Several terms (sebaceous, keratin, epithelial, epidermoid) are used to describe small, fairly common cysts that develop just below the surface of the skin. The U.S. National Library of Medicine refers to them as epidermoid cysts.

The common risk factors for cysts are age (most people get them during their 30s or 40s), gender (men are twice as likely to get them as women), a history of acne, an injury to the skin (any type of crushing or traumatic injury), and long-term sun exposure.

Don’t Worry Unless….

A warm compress might help drain the cyst—do not force the drainage—or your doctor might inject the area with a steroid to reduce inflammation. On rare occasions, surgery is required to remove it. Cysts may recur. You cannot prevent these growths but avoiding excessive sun exposure and using skin products that do not contain oils might help.

Dermatitis

Eczema

Eczema is common and complicated. It’s not one condition; it’s at least seven. In one form or another, eczema affects more than 30 percent of the U.S. population.

Symptoms (in adults):

Dry, scaly skin
Itchy skin
Thickened or cracked skin
Rash that is red, swollen, and sore
Rash that gets worse with scratching
Rash or bumps that may leak clear fluid
Rash that becomes infected

The most common places for the rash to appear are the cheeks, wrists, hands, behind the knees, in the creases of elbows, and on the buttocks. Flares (flare-ups) among those who have had AD as children tend to be milder in adulthood.

Causes and Triggers

The exact cause of AD is unknown, but there are plenty of contributing factors. You are more likely to have AD if a family member has it—or allergies, or hay fever, or asthma. The connection has to do with a genetic variation that alters the skin’s ability to protect itself. The crossed signals also cause the body to overreact to outside forces—triggers—including:

Scratchy clothes
Cleaning products
Soaps
Dust
Animal dander and saliva
Feeling too hot or too cold
Perspiration
Stress

Foods (nuts, dairy products, eggs, fruit juices, soy products, wheat) do not cause AD, according to the AAD, but food allergies may make it worse.

The list of triggers is long, but not every person’s body responds to every trigger. Part of prevention is knowing which substances or events cause your particular symptoms and avoiding them. Diagnosis by a family doctor or dermatologist is relatively straightforward. It consists of a person’s medical history, observation of symptoms, and may require a blood or patch test to determine the trigger.

Treatment

Corticosteroids are still the treatment of choice, but the FDA has approved newer and effective gels, foams, and oils. In March 2017, the FDA approved dupilumab (Duprixent) in injection form to treat adults with moderate-to-severe AD. The medication is intended for patients whose eczema is not controlled by topical drugs or for whom topical therapies are not advisable. Antibiotic, antiviral, and antifungal drugs may be recommended if AD is accompanied by a skin infection. Antihistamines can produce drowsiness when taken at bedtime to reduce itching and scratching. Light therapy (phototherapy) uses ultraviolet (UV) rays to treat moderate cases of dermatitis.

Prevention

Among the home measures you can take is to apply an over-the-counter moisturizer/body lotion every day and within three minutes of bathing or showering, to capture moisture.

Here are other preventive measures:

Take lukewarm baths (so that hot water doesn’t trigger a flare).
Wear soft fabrics, not scratchy ones.
Use mild or non-soap products when washing.
Use a humidifier in dry or cold weather.

Allergic Contact Dermatitis

Propylene glycol was named “Contact Allergen of the Year” in 2018 by the American Contact Dermatitis Society. It is an emollient and emulsifier found in cosmetics, medications, and food, and has been demonstrated to cause systemic contact dermatitis.

Other troublesome contact allergens through the years include:

2007: Fragrance
2008: Nickel
2009: Mixed dialkyl thiourea
2010: Neomycin
2011: Dimethyl fumarate
2012: Acrylate
2013: Methylisothiazolinone
2014: Benzophenones
2015: Formaldehyde
2016: Cobalt
2017: Alkyl glucoside

Irritant Contact Dermatitis

Treatment

Treat itching and other symptoms of most rashes at home with cortisone-based creams to reduce inflammation. Other options are calamine lotions, oral antihistamines, and oatmeal baths. Over-the-counter drugs like Benadryl and Ben-Allergin may also help. Try to resist scratching, which will further inflame the rash.

Diabetes-Related Conditions

Sometimes a skin disorder is the first sign that diabetes is present. Diabetes and skin issues are directly linked. The warm, high-sugar content of the body’s blood is a perfect environment for the growth and development of skin-related bacterial and fungal infections. Anyone can get these skin conditions, but diabetics are more susceptible.

The AAD describes 12 skin-related warning signs of diabetes (see “12 Skin-Related Warning Signs of Diabetes”).

“If you have diabetes, try to avoid trauma and follow up with a podiatrist if your feet are involved or with a dermatologist for any skin conditions,” says UCLA’s Dr. Lorraine Young.

Bacterial Infections

Bacterial infections are treatable with antibiotics and perhaps preventable by controlling blood sugar levels. Nevertheless, diabetics are affected more than nondiabetics, and only a doctor can diagnose the infection and prescribe medications, either in pill or cream form.

Fungal Infections

Athlete’s foot, jock itch, ringworm, and some vaginal infections are fungal infections that affect the general population, but which present special problems for people with diabetes. The cause is often a yeast-like fungus that targets diabetics. It causes an itchy, red area surrounded by small blisters and scales, usually in warm, moist folds of the skin, such as the mouth, vagina, breasts, fingers, toes, nails, and rectum. The fungus can move through the bloodstream and affect other areas of the body.

Diabetic Dermopathy

Diabetic dermopathy is caused by changes in small blood vessels that result in light brown, scaly, oval, or circular patches of skin, often on the front of the legs. The patches do not itch, hurt, or drain and usually do not require treatment.

Necrobiosis Lipoidica

Necrobiosis lipoidica (NL) is a rare condition caused by a change in the blood vessels, and consists of oval plaques, usually on the lower legs. It is similar to diabetic dermopathy, but the spots are larger, deeper, and fewer in number. NL may begin as small red or raised spots, which develop a shiny appearance surrounded by a violet-colored border. The spots often turn brown and fade, but often leave a permanent discoloration. NL can be painful and itchy. Adult women are more susceptible, and diabetics account for two-thirds of all cases. If the plaques break open, see a dermatologist for treatment.

Diabetic Blisters

People rarely develop diabetic blisters on their fingers, hands, toes, feet, legs, or forearms, but it can happen. They resemble blisters caused by burns, but are not painful. Diabetic blisters heal in two to three weeks without treatment. Those who develop the blisters often suffer diabetic neuropathy, a nerve disorder caused by diabetes. The only way to guard against the incidence of diabetic blisters is to keep blood sugar levels under control.

Eruptive Xanthomas

Eruptive xanthomas (EX) develop when diabetes has gotten out of control. The symptoms are small, firm, yellow-red bumps on the skin. A red circle surrounds the bumps, and the area may itch. EX often appear on the backs of hands, feet, arms, legs, and buttocks. A person at risk has type 1 or type 2 diabetes and elevated blood lipids. However, the bumps disappear once the person’s blood sugar level returns to acceptable levels.

Prevention

The AAD suggests the following measures to prevent or reduce the risk of diabetes-related skin diseases:

Keep skin clean and dry by using talcum powder where skin touches skin.
Avoid hot baths and showers, and do not put lotion between your toes. Warm, moist surfaces are breeding grounds for infections.
Prevent dry skin by using moisturizers, especially in cold, windy weather.
Treat cuts immediately. Wash them with soap and water, but avoid products that are too harsh, such as alcohol and iodine.
Use antibiotic cream only if advised to by your doctor.
Keep your home more humid than normal during cold, dry months.
Bathe less, if practical.
Use mild shampoos and avoid feminine hygiene sprays.
See a dermatologist for skin conditions you cannot treat.

Folliculitis

Granuloma

Granulomas are small nodules (bumps) that can develop throughout the body and can range in severity from benign to malignant. They are relatively common in adults.

The two types that can affect the skin are called pyogenic granuloma (caused by an injury to the skin) and granuloma annulare (the most common form).

The pyogenic variety, most often found on the arms, hands, and face, might resolve without treatment, but most of the time they have to be removed surgically.

Herpes Simplex

The herpes simplex virus (HSV 1) causes cold sores and blisters around the mouth. The sores may sting, burn, tingle, or itch. A different kind of herpes virus—herpes zoster—causes chickenpox and shingles, and herpes simplex type 2 causes genital herpes.

Many people become infected when they are exposed to the virus, but no more than 10 percent develop symptoms, which occur two to 20 days after contact with a person who has been infected. The blisters may heal on their own, or they may break and allow fluid to drain. Creams and ointments usually work for mild cases. The scab, or crust, eventually falls off. The virus that caused the outbreak stays in the body and may reappear later.

Prescription antiviral medications like acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) are effective for more serious cases. Preventing HSV 1 is possible by avoiding physical contact with an infected person and not sharing cups, glasses, or eating utensils.

Hives

Hives are welts that itch. The condition is produced by blood plasma leaking through small gaps between the cells lining the small blood vessels in the skin. The condition appears as red, raised areas in irregularly shaped sizes ranging from small to several inches across.

Acute Hives

Chronic Hives

Relieve the Symptoms

The goal of treatment is to relieve the symptoms, and that may be done with cool compresses or showers, damp cloths, loose-fitting clothes, minimizing vigorous physical activity, and avoiding uncomfortably warm environments.

Over-the-counter (OTC) antihistamines like Benadryl, Chlor-Trimeton, Zyrtec, Tavist, and Claritin counter the effects of the histamine produced by the body, as can prescription drugs, such as hydroxyzine (Atarax, Vistaril), desloratadine (Clarinex), fexofenadine (Allegra), and levocetirizine (Xyzal). These medications may be taken in combination with drugs known as histamine-2 (H2) blockers, like Zantac and Tagamet.

Before taking any OTC or prescription medications, let your doctor know which other drugs you take, including supplements. Doing so could prevent drug interactions that could cause complications. Any type of drug therapy should be designed for your specific needs.

Keep a Food Log

Eggs
Milk
Nuts
Fish
Berries
Chocolate
Tomatoes

Heat Rash

Heat rash is a hot weather-related condition that affects all ages.

The condition has many names, including prickly heat, miliaria, and summer rash. No matter what it’s called, the condition is an inflammation of the skin caused by blocked sweat glands. It is uncomfortable and itchy, but can be treated at home and usually goes away within a few days, with or without treatment.

Risk Factors

Causes of Heat Rash

Sweat glands are located in the second layer of skin called the dermis. When sweat ducts are blocked, perspiration cannot get to the surface and evaporate. Instead, it gets trapped under the skin where it causes mild inflammation resulting in a rash. The combination of sweating heavily when exercising while wearing clothes that don’t allow the sweat to evaporate can also trigger the rash. Heat rash can even happen during the winter if people wear too much clothing or sit close enough to a fire or heater to sweat.

Symptoms, Diagnosis

There are actually four types of heat rash, all of which have medical terms most of us wouldn’t recognize or use. They are easier to remember by how the rash looks—red, white, clear, or deep.

Red heat rash is the most common form. It’s called “prickly heat” because it itches and burns. The inflammation causes a reddish-colored rash.
A yellow or white rash might be a sign of infection and a reason to have it checked by a doctor.
Clear heat rash looks like small, clear beads of sweat on top of the skin. It is the mildest form and not likely to cause any discomfort or itching.
Deep heat rash is caused by repeated episodes and chronically inflamed sweat glands. Deeper layers of the skin are affected and the rash may appear as large, firm bumps.

Treatment

Heat rash is uncomfortable but treatable. The first step is to stay cool. The rash may disappear simply by cooling the skin. Here are some specific suggestions.

Avoid activities that cause sweating.
Stay in the shade when outdoors and in air-conditioned spaces
when inside.
Wear breathable clothes (loose-fitting, loose-woven, thin, moisture-wicking, quick-drying).
Take cool showers and use mild, antibacterial soaps.
Use over-the-counter, anti-itch medications containing calamine, menthol, or camphor to relieve symptoms.

Be careful about oil-based skin products. They can clog up pores and make heat rash worse.

See Your Doctor If …

Although heat rash can be uncomfortable, it is usually mild and goes away quickly. Common sense and home remedies are enough to keep the doctor away in most cases.

Impetigo

Impetigo is caused by a bacterial infection that produces crusty skin lesions that itch first and ooze later. A doctor often can diagnose impetigo simply by looking at it.

Lichen Simplex

Lichen simplex (chronicus) is a localized, very itchy patch of skin that develops after repetitive scratching and rubbing. The itch could be there because of any one of several skin conditions, including psoriasis, eczema, a fungal infection, or an insect bite. Other symptoms are a leathery or scaly texture of the affected areas, or a raised patch of skin that is red or darker than the rest of your skin.

Women are more likely to develop lichen simplex than men. It usually occurs between the ages of 30 and 50.

Treatment options are topical steroids, steroid injections, moisturizers, cooling creams that contain menthol, and antihistamine or antidepressant medications to help you sleep.

Lupus

Lupus can affect anyone at any age, but women get it more often than men. It is typically diagnosed between ages 15 and 45 and is more common in Asians and African-Americans than in other ethnic groups.

Symptoms, Diagnosis

A skin rash called a “butterfly rash” is at the top of the list of symptoms. It is a reddish eruption across the bridge of the nose and cheeks. Other symptoms of lupus include fever, fatigue, and weight loss; a rash in an area exposed to sunlight; raised, scaly patches; arthritis involving multiple joints for several weeks; mouth or nose ulcers; kidney problems (detected with blood tests); anemia, low blood cell count, or low platelet counts; and seizures.

Treatment

Lyme Disease

Lyme disease is caused by four kinds of bacteria and spread when people are bitten by a blacklegged deer tick. But not all ticks carry the bacteria and not all people bitten by the tick get the disease.

The early symptoms usually appear within 30 days of a bite. At first, there will be a red and itchy spot as big as a quarter. It is caused by the immediate bite itself but is not a sign of Lyme disease.

Poor sleep has emerged as a symptom of Lyme disease patients. A 2018 study published in the journal SLEEP found that people who have the condition report poor sleep quality before treatment and significantly worse sleep and sleep disturbance six months after treatment.

Contact your physician if you get a bulls-eye looking rash, flu-like symptoms, fever or chills, muscle or joint pain, headaches, fatigue, or weakness. It is diagnosed by a physical exam and blood tests. If untreated, the disease can spread to the heart, joints, and nervous system.

Treatment with antibiotics is normally successful within a few weeks. If Lyme disease is detected later, antibiotics are still the treatment but it may take longer to get rid of the symptoms.

A person who has had Lyme disease once can get it again. There is no known vaccine, so reducing exposure is the best way to prevent it.

Moles

Moles are clusters or spots on the skin that consist of melanin cells called melanocytes, which give color to skin. They are either dark brown, reddish-brown, blue, or the color of skin. They vary in shape and size, but most are oval or round, and are less than one-quarter-inch in diameter. Moles can be flat, raised, smooth, or wrinkled. Atypical moles are larger than a pencil eraser and usually have a dark brown center with a lighter, uneven border. They tend to run in families.

Most people have between 10 and 40 moles on average, and their presence was probably determined at birth. They can develop on any area of the body, including the scalp, between fingers or toes, and under fingernails and toenails. The number of moles can change with age, with some fading as a person moves into adulthood, and others disappearing altogether or lasting 50 years or longer. Sunlight can increase the number of moles and make them darker.

Most moles are harmless and will never be a health threat, but in some cases they may lead to a higher risk of certain cancers. Traditionally, people who had the greatest number of moles were thought to have a greater risk of developing a melanoma. However, a recent study in JAMA Dermatology suggested that physicians should not rely on the total number of moles as the only reason to perform an exam or determine a patient’s risk.

Tell Your Doctor If . . . .

The National Cancer Institute says to tell your doctor if you notice any of the following changes in a common mole:

The color changes.
The mole gets unevenly smaller
or bigger.
The mole changes in shape, texture, or height.
The skin on the surface becomes dry or scaly.
The mole becomes hard or feels lumpy.
It starts to itch.
It bleeds or oozes.

A Gene May Tell the Difference

University of Pennsylvania scientists appear to have discovered a gene that differentiates moles from melanomas. By staining tissue samples, a low level of the gene p15 indicated a melanoma. A high expression of p15 would be consistent with a benign mole.

A biopsy can determine if a mole is malignant, and a mole can be removed by shave excision (using a small blade to cut it out), punch biopsy (removing the mole with a small device that works like a cookie cutter), and excisional surgery (which involves taking out the mole and the skin around it). All of the procedures can be performed in a dermatologist’s office. Once removed, most moles do not recur. If one does, let your doctor know.

Methicillin-Resistant Staphylococcus Aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a potentially dangerous staph bacterium that is resistant to certain antibiotics. It may cause skin and other infections throughout the body. The bacterium is carried by 2 percent of the population, but few are infected. Those who have weak immune systems are most vulnerable, especially those in hospitals, nursing homes, and other health-care facilities. The symptoms of MRSA may include a fever, and a bump or infected area of the skin that has one or more of the following conditions:

Red, swollen
Painful, warm
Filled with pus

Treatment

Treatment may involve draining the infection and taking an antibiotic, and it is important to continue taking the medication even if the infection appears to get better. Oritavancin (Orbactiv) is given in a single dose and may become an option for the treatment of MRSA, and other skin infections.

Researchers at the Los Angeles Biomedical Research Institute have challenged the current Centers for Disease Control and Prevention (CDC) strategy for dealing with MRSA in hospitals, which stresses limited contact between patients and staff. Their research showed that bathing patients in a common hospital soap called chlorhexidine was just as effective as limiting contact and could result in better quality of care because of increased contact.

Three anti-MRSA antibiotics—dalbavancin (Dalvance), oritavancin (Orbactiv), and tedizolid—were approved by the FDA in 2016.

Prevention

The best ways to prevent MRSA are:

Know the signs.
Get treatment early.
Practice good hygiene, especially by washing hands often.
Do not share personal items, such as towels and razors.
Follow prescription drug instructions precisely and complete the prescribed course, even if symptoms subside.

Take All of Your Medicine

A study published in Antimicrobial Agents and Chemotherapy found that patients with certain skin infections took, on average, only 57 percent of their prescribed antibiotic doses after leaving the hospital. Nearly half of 87 patients developed a new infection or needed additional treatment for the existing skin condition.

Poison Ivy, Poison Oak, Poison Sumac

Unless you live in Alaska, Hawaii, a desert, or at a high altitude, poison ivy is creeping around nearby. If you don’t stay away from it, you may be one of the 50 million Americans affected each year.

Poison ivy, poison oak, and poison sumac all contain an oil called urushiol. It can cause an allergic reaction in the form of a blistering rash and an impossible-to-ignore itch. The poisonous plant presents three problems: recognizing it, treating it, and avoiding it.

What They Look Like

Poison ivy’s basic summer appearance is a vine or shrub that has green, three-leaf, pointed clusters. It can appear as ground cover, upright in bushes or shrubs, or as vines that grow up trees or rock walls. Several other plants (box elder, raspberries, blackberries) have a similar appearance. Poison ivy’s color changes with the seasons:

In spring, the leaves emerge with a reddish color.
In summer, they’re green. The plant may also have clusters of light green or cream-colored berries.
In the fall, the leaves change to shades of red, orange, or yellow.
In winter, its leaves disappear, but the leafless vines can still produce enough of the oil to cause a rash after contact.

Treatments

Poison ivy, oak and sumac are a year-round nuisance, but they are especially toxic in spring and summer. A nick or quick brush against the plant is all it takes. Its symptoms—a red rash, blisters, and itching—can appear within a few hours of exposure or as long as 12 days afterwards. Without treatment, the symptoms go away in two to three weeks.

If you know you’ve come into contact with poison ivy, oak or sumac flush your skin with lukewarm, soapy water as soon as possible (every minute counts), says the AAD. Then do it again. Don’t scratch, and don’t break the blisters when they appear.

Oral antihistamines can relieve itching, as can wet compresses and short baths in warm or cool water. Over-the-counter topical corticosteroid preparations might help, or you might try trade-name products such as Calamine Lotion or Aveeno. See a doctor or go to the emergency room if:

You have a temperature over 100 degrees Fahrenheit.
The affected area develops pus or soft yellow scabs.
The rash spreads to your eyes, mouth, or genital area.
You have trouble breathing.
Home remedies don’t ease the symptoms.

Not Contagious

There is some good news regarding a mostly-bad-news situation. The rash is not contagious and does not spread. It might appear to be spreading, but it’s because of a delayed reaction to urushiol in the areas of skin affected.

Prevent Exposure

Wear long sleeves and pants tucked into garden boots if you are going to be working near poison ivy, oak or sumac. Use gloves that don’t allow fluids, including oils, to pass through.
Wash any item of clothing that has been in contact with poison ivy, oak or sumac and regularly wash garden tools.
Use pet shampoo to wash a dog that may have brushed against one of these plants. Pets aren’t sensitive to the oil, but if it gets on their fur and you touch it, you’ll have a reaction.
Don’t put poison ivy, oak or sumac leaves in a campfire or when burning leaves in your yard. Urushiol can go airborne.

Recognize, Avoid

Poison ivy, oak and sumac can be easily pulled out in early spring if only a few plants are involved. Pull out the entire root system, if possible, and put it in a plastic bag to be taken away.

When the plants have been in an area for a long time, it is almost impossible to remove the plant and its root system. The best way to protect yourself is to stay away from it.

Psoriasis

Even though psoriasis affects up to eight million people in the United States, about 40 percent of psoriasis patients do not get treatment. There are five types of psoriasis, and each has unique symptoms, but 80 percent of people get the most common variety: plaque psoriasis.

Who Gets It?

Psoriasis and other diseases are associated with metabolic syndrome (a group of risk factors associated with diabetes and stroke that include a large waistline, high triglycerides, low HDL cholesterol, high blood pressure, and high fasting blood sugar) and may be a precursor to diabetes and cardiovascular disease, according to 2018 research conducted in Greece and the United Kingdom. Approximately one-third of psoriasis patients have a family history of the disease.

What Causes It?

Psoriasis occurs when T-cells that normally protect the body against infection and disease develop and rise to the surface at a faster-than-normal rate. They accumulate on the top layer of skin before they have time to mature.

The discovery of a mutation in the CARD14 gene suggests that the mutation, plus an environmental trigger, is enough to cause psoriasis. Scientists now have a much clearer picture of what is happening in psoriasis, and targeted therapies are being developed.

Skin cell turnover usually takes about a month, but in psoriasis it can happen in a few days. This process results in patches of thick, inflamed skin covered with scales that itch and can hurt.

They appear anywhere on the body, but show up most often on the elbows, knees, legs, lower back, face, palms, soles of the feet, and scalp. The symptoms can be only a nuisance or serious enough to interfere with work, recreation, and daily life
and functions.

Symptoms Come and Go

They include red patches, silver scales, dry skin, cracked skin that can bleed, thick or ridged nails, and swollen or stiff joints. A new episode can be triggered by infections, injuries to the skin, smoking, cold temperatures, stress, alcohol consumption, and certain medications, including lithium, beta blockers, and antimalarial drugs. Excessive body weight also can increase the risk of psoriasis.

Excessive inflammation is a critical feature, and since it is also a characteristic of insulin resistance, obesity, high cholesterol levels, and cardiovascular disease, psoriasis patients should consult with their health-care providers to watch closely for signs of these conditions.

Three-Phase Treatment

Psoriasis can be difficult to diagnose. It is not curable, but it is treatable. See a doctor if your condition is more than a nuisance, if it interferes with daily activities, and if you are concerned about the appearance of your skin. If your doctor cannot make a diagnosis by observation, he or she will take a skin sample and examine it under a microscope.

Physicians often use a three-step treatment approach, which includes topical medication, phototherapy, and oral or injectable drugs.

Step 1 (one or more of the following):

Corticosteroids to reduce inflammation and slow cell turnover.
Calcipotriene, a synthetic form of vitamin D, to limit cell production.
Retinoids, a synthetic form of vitamin A, to normalize DNA activities in cells.
Moisturizers to reduce itching, scaling, and drying.

Step 2

Photodynamic therapy to slow the rate of cell turnover.

Step 3 (one or more of the following)

Methotrexate (Rheumatrex, Trexall)
Retinoids
Cyclosporine (Gengraf, Neoral)
6-Thioguanine
Hydroxyurea (Droxia, Hydrea, Siklos)
Antibiotics
Biologics

Treating Psoriasis at Home

The AAD suggests several strategies for dealing with psoriasis. They include:

Bathe daily to remove scales and reduce inflammation, but avoid hot water and harsh soaps.
Use moisturizers to prevent drying of the skin.
Cover affected areas at night with moisturizers, and lightly cover with plastic food wrap.
Use cortisone to reduce inflammation, such as over-the-counter creams with 0.5 to 1 percent cortisone.
Avoid triggers such as stress, smoking, excessive sun exposure, and drinking alcohol.
Try not to scratch.

Psoriatic Arthritis

Psoriatic arthritis is a form of inflammatory arthritis. Its symptoms vary widely and make it difficult to diagnose, even for physicians. X-rays, joint fluid tests, and blood tests are used to make a diagnosis.

Patients report pain and stiffness in the knees, ankles, and joints of the feet, although other areas can be affected. Inflamed joints may be swollen and hot, and stiffness and pain are often worse in the morning than at other times. Patients also may have inflamed tendons and inflammation in the eyes, lungs, and aorta. Acne is a common side effect.

Psoriatic arthritis can develop at any age, but it most often occurs in adults between ages 25 and 50. Genes, environmental factors, and the immune system appear to play a role in its development. Psoriasis precedes psoriatic arthritis by months or even years.

Suppress the Symptoms

The goal of treatment is to suppress symptoms rather than cure the disease. Doctors first try NSAIDs, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).

If they do not work, disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, antimalarials, sulfasalazine, cyclosporine, and tumor necrosis factor (TNF) inhibitors, are prescribed. TNF drugs, such as etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), are effective for psoriasis and psoriatic arthritis.

The FDA has approved the drugs golimumab (Simponi) and ustekinumab (Stelara) for the treatment of psoriatic arthritis. They also have approved a drug called apremilast (Otezla) to treat psoriatic arthritis by blocking enzyme-related inflammation.

A rheumatologist should treat psoriatic arthritis if arthritis is the focus. If the primary symptoms involve only the skin, a dermatologist should treat them.

Rocky Mountain Spotted Fever

Don’t let the name fool you. Although the Rocky Mountain states are where it was first identified, Rocky Mountain spotted fever is more common in the southeastern and southcentral states than in other parts of the country.

Rocky Mountain spotted fever is caused when an infected wood tick or yellow dog tick bites a person. People are bitten most often from March to September, when the ticks are active and people are in tick-infested areas.

Symptoms

Rocky Mountain spotted fever is a serious and sometimes deadly bacterial infection that begins with a rash, headache, and high fever that can get worse quickly if it’s not diagnosed and treated. The rash does not itch, but it spreads rapidly from the wrists and ankles in both directions to the palms, soles, forearms, necks, armpits, buttocks, and trunk —however, 10 percent of people with the condition do not develop a rash.

Untreated cases of the disease result in death up to 80 percent of the time. Early treatment with antibiotics has reduced the death rate to about 5 percent.

Prevention

Stay on paths and trails.
Tuck trousers into shoes, socks,
or boots.
Wear light-colored clothing to spot ticks more easily.
Wear long-sleeved shirts.
Use tick repellants such as DEET.
Search quickly for tick bites.
Remove ticks as soon as you find them.

Rosacea

Rosacea is a common, chronic, incurable condition characterized by redness and visible blood vessels in the face. It has been classified into four subtypes, which are described by the National Rosacea Society (NRS). See “Rosacea Subtypes and Symptoms.” More than 16 million people in the United States have rosacea and most of them don’t know it.

Targets

The cheeks, forehead, chin, and nose are the primary targets of rosacea. The neck, ears, chest, and back are less frequently involved. In 50 percent of people with rosacea, the eyes may be watery, red, or irritated. Other possible symptoms are a sensation of burning, itching, or stinging, dry or thick skin, and facial swelling.

Individuals most susceptible to rosacea have fair skin, blush easily, are between ages 30 and 60, and have a family history of the condition. Women are affected more often than men, but that may be because men wait longer to seek treatment.

Unknown Cause

The cause of rosacea is unknown, but recent research revealed that an immune response might play a role in its development. Through skin biopsies, a team of international researchers found that people with rosacea had unusually high levels of cathelicidins (types of proteins), peptides, and inflammatory properties that protect skin against infection. They also discovered that an enzyme known as SCTE was elevated in people with rosacea.

Family History

A family history of rosacea places people in a higher risk category, as do high rates of blistering sunburn. The NRS reports a connection between rosacea and national origin. Individuals with Irish, English, and German ancestry appear to be at higher risk.

Rosacea has psychological as well as physical consequences. A survey conducted by the NRS found that more than 75 percent of patients said their condition lowered their self-confidence and self-esteem. Fifty-two percent said it was the reason they avoided public contact and cancelled social engagements.

Increased Risk of Three Cancers

A study of 49,475 rosacea patients in Denmark found that, when compared to a control group of more than 4 million people, those with the condition had higher rates of liver cancer, non-melanoma skin cancer, and breast cancer, but a decreased risk of lung cancer. The findings were published in Cancer Epidemiology.

Oral and Topical Medications

Topical medications include azelaic acid, benzoyl peroxide, clindamycin, erythromycin, metronidazole, sulfacetamide, and sulfur lotions. Keep in mind that it might take two or three months to get significant results. The AAD issued a statement acknowledging that skin prone to acne or rosacea may improve with daily probiotic use.

Pimples and bumps may respond better to oral antibiotics, including doxycycline, erythromycin, minocycline, and tetracycline.

Oral antibiotics also may be combined with glycolic acid peels and glycolic washes and creams. Isotretinoin is not approved by the FDA for this condition, but some doctors prescribe it (off-label use) to help shrink facial skin that has thickened. However, it can have serious side effects, such as nosebleeds, dry skin, dry mouth, and itching.

The FDA approved the topical cream ivermectin (Soolantra) in 2014 for the treatment of inflammatory lesions of rosacea. Subjects who used the cream achieved “clear” or “almost clear” rates 38 to 40 percent of the time, compared with 7 and 19 percent of the time in a control group.

When the eyes are affected, patients should gently clean their eyelids with diluted baby shampoo, or an over-the-counter eyelid cleaning substance. Warm compresses applied several times a day also might relieve the symptoms. Oral antibiotics, such as doxycycline, minocycline, or tetracycline, are prescribed at times.

Dermatologists may use electrosurgery or laser surgery to address redness and flushing. Among recent innovations are pulsed dye lasers that destroy visible blood vessels and reduce flushing and redness. Intense pulsed light therapy delivers light to the affected areas, where it targets blood vessels and redness.

Avoid Triggers

Rosacea cannot be prevented, but the symptoms can be controlled once they have developed. The first step is to avoid possible triggers. “Rosacea Triggers by Percent Affected” shows the results of a survey taken by the NRS of more than 1,000 patients regarding factors that produce an episode.

Use a 30 to 50 SPF sunscreen when outdoors, and a moisturizer during winter to prevent dry skin. Consider keeping a diary to identify substances, activities, and environments that could cause a flare-up.

Scabies

Older adults, especially those with weakened immune systems, are at a higher risk for scabies than younger, healthier people. Scabies is an infestation of the skin by a microscopic mite. It is a common condition found around the world, and spreads rapidly in crowded conditions where there is frequent skin-to-skin contact. It can happen in hospitals, nursing homes, and other institutions, but prolonged contact is usually needed to transmit the infection. A casual handshake or hug is not likely to cause a problem.

It could take four to six weeks after contact for symptoms to develop. The symptoms include skin irritation or a rash, usually between the fingers or on the wrists, elbows, knees, breasts, or shoulder blades. Your doctor can prescribe a topical cream or lotion to get rid of the infestation, although the symptoms may last a week or two longer.

Seborrheic Keratosis

Seborrheic keratosis (SK) looks like a wart-like tumor on the surface of the skin and may be mistaken for skin cancer. It is neither, but SK is a common skin growth in older adults.

SK can be yellow, brown, black, or other colors. The lesions are more common on the face, chest, shoulders, and back than on other places of the body. Some of them turn black, which is why they may be mistaken for skin cancer, but biopsies almost always determine them to be noncancerous.

SK can appear alone or in clusters, have a rough or smooth texture, and do not penetrate deeply into the skin. They can be quite small or more than one inch in diameter and are painless. However, rubbing or scratching can cause inflammation.

Not Contagious

Descriptions of SK include the term “stuck on” or “pasted on,” as if someone dabbed a patch of candle wax onto the skin. They are not contagious, but they do seem to run in families.

Their cause is unknown, though as the name suggests, SKs have an oily, waxy substance similar to that produced by sebaceous glands. Expert opinions are mixed as to whether ultraviolet light exposure causes SK.

The AAD says exposure to sunlight does not seem to be a cause or a complicating factor after SK has developed. However, the Mayo Clinic believes exposure to sunlight may be a factor because the condition is common in areas often exposed to the sun.

Unsightly, Not Dangerous

The best news about SK is that it is not dangerous, and usually does not need to be removed. People who have them removed do so because of their unsightly appearance or because the growths get irritated, itch, or bleed. However, note that insurance companies do not cover procedures to remove them for cosmetic purposes.

Also, do not waste your money on creams, ointments, or other over-the-counter products that claim to remove the growths. They don’t work.

A dermatologist can remove an SK during an office visit by cryosurgery (using liquid nitrogen), curettage (scraping them off the skin), electrosurgery (by means of an electrical current, sometimes combined with curettage), or laser surgery (using high-intensity light beams to destroy the growth). In 2017, the FDA approved a topical solution for the treatment of seborrheic keratosis.

Don’t confuse seborrheic keratosis with actinic keratosis. Actinic keratosis, also called solar keratosis, is considered to be the earliest stage of skin cancer that is limited to the outermost layer of skin.

Shingles

Almost one in three people in the United States will develop shingles during their lifetime. Most will get it once, but it’s possible to get it a second or third time. The majority of people who get shingles are over age 60.

Shingles causes a rash or blisters on the skin. It is a viral disease—the same one that causes chickenpox. After chicken pox heals, the virus becomes dormant in the body, but it can emerge again if a person’s natural resistance is compromised.

Those who are at the greatest risk for shingles have a weakened immune system, are over the age of 50, have been ill, are experiencing trauma, and/or are under stress.

The symptoms of shingles often include itching, stabbing, or shooting pains. The skin appears red in the affected area. Other symptoms are fever, chills, headache, and an upset stomach. A rash appears after a few days around the waistline or on one side of the face or trunk.

There is no cure for shingles, but treatment with antiviral medications—such as acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir)—can help ease the pain and discomfort and reduce the duration of symptoms.

A new shingles vaccine called Shingrix was approved by the FDA in October 2017. The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get two doses of Shingrix, two to six months apart.

Skin Tags

A skin tag is a small, benign, elongated, skin-colored growth that is common in people older than age 60. The condition is also known as an acrochordon. It is made up of a core of fibers and ducts, nerve cells, fat cells, and a covering. Some have a stalk.

A tag sticks out of or looks like it is hanging from the skin, usually near the neck, armpits, trunk, breasts, or other areas of the body where the skin folds. Some may be darker than the skin color.

Skin tags occur in approximately 46 percent of the population, and the incidence increases with age. The number goes up to 59 percent by the age of 70.

Skin tags are present in both men and women, although they are associated with pregnancy in some women. Skin tags are also more common in patients with type 2 diabetes and in people who are obese. Two studies have found that people who have multiple tags were more likely to have insulin resistance.

Linked to Metabolic Syndrome

Skin tags appear to have an association with metabolic syndrome. There is some evidence that susceptibility may be genetic.

Skin tags do not grow (they are usually just a fraction of an inch in diameter), they do not hurt, and they are not a form of skin cancer. The only potential problems are 1) they are not attractive and 2) they can become irritated if clothes or jewelry rub against them. They also may develop because of skin rubbing against skin and are more common in those who are overweight or have diabetes. Unusually large tags may burst and bleed under pressure.

Easy to Diagnose and Treat

A skin tag is easily diagnosed and treated. It can be removed during an office visit by excision (cutting it out), cryotherapy (freezing it), cauterization (burning it off with an electrical current), or ligation (interrupting the blood supply). Removing larger tags may require a local anesthetic. A skin tag on the eyelid may have to be removed by an ophthalmologist.

The National Institutes of Health (NIH) do not recommend that a person attempt to remove a skin tag without medical assistance because of the risk of bleeding and infection. Over-the-counter products are available, but not recommended by any national health organization in the United States.

Tags do not normally come back at the same site, but new growths can develop elsewhere on the body. There is no evidence that removing a skin tag causes more to develop. Some tags just fall off, but in most cases, they don’t.

You cannot prevent skin tags—they just happen. But unless they regularly become irritated, unsightly, or change in color, size, composition, or sensitivity, there is no reason to treat or report them.

Sunburn

Most, if not all, skin diseases are caused by overexposure to the sun. If the sun does not cause them, many of them are made worse by exposure to the sun’s UV rays. However, there are benefits to sun exposure, particularly in the case of UV rays, which help the body produce vitamin D that older adults often lack.

The key is to minimize your sun exposure and make efforts to protect yourself at all times. Of course, the most immediate, short-term problem caused by the sun is sunburn. According to the NIH, sunburn occurs when the amount of exposure to UV rays, whether from the sun or from artificial sources, exceeds the body’s ability to produce melanin. Melanin is a protective pigment responsible for tanning, and a suntan is the body’s way of shielding itself against UV rays.

Four Hours After Exposure

Sunburn symptoms begin to appear about four hours after exposure, get worse during the next six to 48 hours, and begin to subside in three to five days. In a mild case of sunburn, the skin becomes red or pink, warm, and tender. In more severe burns, the symptoms also include pain, swollen skin, and possible blisters.

By the time your skin is painful and red, the damage has been done. If a large area is burned, you might have a headache, fever, nausea, or fatigue. The skin will begin to peel three to eight days after exposure. Recovery ranges from several days to three weeks.

Any part of the body can be sunburned, including the eyes. Sunburned eyes are red, dry, painful, and gritty-feeling. Long-term effects of chronic exposure to the sun include cataracts and perhaps macular degeneration, an age-related loss of central vision.

Older adults and young children are more susceptible to sunburn than young and middle-aged adults. A study of more than 100,000 nurses found that those who had at least five blistering sunburns between the ages of 15 and 20 had an 80 percent higher risk for melanoma, and a 68 percent greater risk of basal cell carcinoma and squamous cell carcinoma.

Not everyone reacts to the sun the same way. It often depends on skin type, length of exposure, time of day and year, geography, and drugs that person is taking.

Which Skin Type Are You?

Of the many factors associated with sunburn, one of the most important is skin type. Several organizations, including the Skin Cancer Foundation, classify skin types from light to dark (see Chapter 3).

The closer you are to Type I (very fair, white skin), the greater your risk of sunburn now and skin cancer later. The darker your skin, the more pigmentation it has to protect itself against the sun.

How Long Does It Take?

A Type I or Type II person can get a sunburn in as little as 15 minutes, while a person with darker skin may be able to tolerate the same amount of exposure for several hours.

When Am I at Highest Risk?

The highest risk for sunburn is between 10 a.m. and 4 p.m., and exposure during the summer months is most dangerous.

Higher-Risk Locations

Snow, water, and light-colored sand reflect UV rays and increase the chances you will suffer sunburn. Keep in mind that clouds may feel like protection, but in fact they do not help, as up to 80 percent of UV rays penetrate cloud cover. The higher the elevation and the closer you are to the equator, the greater your risk. The worst possible situation would be swimming or snow skiing at a high altitude in a country near the equator.

Drugs That Increase the Risk

Several drugs increase your sensitivity to sunlight and the risk of being burned. Among them are ibuprofen, sulfa antibiotics (Gantanol), doxycycline (Adoxa, Monodox), tetracycline (Periostat, Vibramycin), and diuretics (Diuril, Edecrin).

No Quick Cure

There is no quick cure for sunburn. Aspirin, acetaminophen (Tylenol), and ibuprofen relieve pain and reduce fever. Drink plenty of water to replace lost fluids. Cool baths and wet cloths might feel good, as will moisturizing creams. A low-dose (0.5 to 1 percent) hydrocortisone cream might reduce the burning sensation and hasten the healing process.

If blisters develop, cover the area with a light bandage or gauze. Breaking the blisters will increase the possibility of infection, so allow them to resolve on their own.

See a doctor if more than 15 percent of your body is affected (for example, the upper and lower back, plus the buttocks, constitute 18 percent of your body’s skin). Also see medical help if you are dehydrated, have a fever exceeding 101 degrees Fahrenheit, or the pain persists longer than 24 hours.

Five Ways to Reduce the Risk

Sunscreen makes a significant difference in how the sun’s rays penetrate skin. To understand how deeply UVA and UVB rays penetrate the skin with and without protection, see “UV Penetration into the Layers of Skin.”

Here are five sunburn prevention tips provided by the CDC and NIH:

Use a full-spectrum sunscreen of 30 to 50 SPF.
Apply sunscreen 20 minutes before being exposed to the sun, and reapply every two hours—sooner if you are in and out of water, or if you perspire heavily.
Wear dark clothing with a tight weave to block UV rays.
Wear a wide-brimmed hat that protects the scalp, face, ears, and neck.
Avoid tanning beds.

No Guarantees

Use of a sunscreen does not guarantee protection against skin cancer. A study in Norway found that although some people use it, they don’t necessarily apply the right amount, they forget to reapply, or they don’t apply it to all exposed areas.

A second study of more than 2,187 participants conducted by University of Minnesota researchers found that use of sunscreen decreased on cloudy days even though 80 percent of the sun’s rays can still penetrate the skin, and that men used free sunscreen less often
than women.

Check the UV Index

Before you venture outside, always check the UV Index Risk Level provided by the Environmental Protection Agency. The index ranges from a low of one to a high of 11. Take extra precautions when the index is six to seven or higher.

Look for Your Shadow

An easy way to tell how much UV exposure you get is to look for your shadow. If your shadow is taller than you (like in the early morning and late afternoon), your UV exposure is likely to be low. If your shadow is shorter than you (around midday), you are being exposed to high levels of UV radiation. When this occurs, seek shade and take precautions to protect your skin and eyes.

Slip, Slop, Slap, Seek, Slide

One of the most successful health education initiatives ever conducted in Australia was called “Slip, Slop, Slap”—Slip on a shirt, Slop on sunscreen, and Slap on a broad-brimmed hat. The original slogan has now been expanded to “Slip, Slop, Slap, Seek, and Slide,” and exported to the United States and other countries. “Seek” means to find some shade. “Slide” is a bit of a grammatical stretch, but good advice: Slide on a pair of wrap-
around sunglasses.

Tattoos

They say the two happiest days of a boater’s life are the day they buy a boat and the day they sell it. The same might be said of people who get tattoos.

The prevalence of “tattoo regret” has skyrocketed, and the tattoo removal business is up 440 percent over a recent 10-year period. The industry has the potential for more growth as younger, tattoo-friendly generations age.

The risks of tattoos include allergic reactions, skin infections, granuloma (inflammation), bloodborne diseases, and possible interference with magnetic resonance imaging (MRI).

The most efficient way to remove a tattoo is with a “quality-switched” laser. Its high-intensity light beams break ink into particles small enough for the body to absorb.

Laser tattoo removal has limitations in the colors it can erase and with the added difficulty caused by more vibrant tattoo colors, according to the British Journal of Dermatology. People with darker pigmented skin tend to have less success with certain lasers and require more sessions to avoid skin damage.

It takes three to 10 treatment sessions to remove a tattoo, generally scheduled four to six weeks apart. There is no guarantee that a tattoo will be completely erased, but it’s possible, and something (partial removal) might be better than nothing (having a tattoo that you no longer want).

Vitiligo

In vitiligo, the skin loses its color and white patches develop because the melanin cells are destroyed. The condition can occur anywhere on the body, including skin, hair, scalp, eyebrows and eyelashes, and beard.

The exact cause is not known, but a combination of genetic, immunologic, and environmental factors might be involved. Some people attribute their onset of vitiligo to stress or an emotional trauma, such as an accident or the death of a friend or family member. Whatever the cause, certain people seem to have a greater tendency to develop the condition when exposed to the right (or wrong) trigger. The loss of hair or skin color often begins before the age of 40. Vitiligo can have an emotional impact because the skin is not evenly colored.

Treatable

Repigmentation therapy—which involves recruiting new pigment cells from nearby areas of skin or hair—is one approach to restore pigment. Its effects are limited by the time required and the space to
be re-pigmented.

Other approaches involve topical compounds, phototherapy, and surgery. Complete repigmentation is rare. The final, and perhaps best, strategy for some people is the use of cosmetics to cover the discolored skin.

The drug tofacitinib (Xeljanz), normally used to treat rheumatoid arthritis, may be effective to restore skin color to vitiligo patients. Treatment with tofactinib promotes the growth of melanocytes. A combination of two treatments for vitiligo may be more effective than either treatment alone, according to a 2018 study published in JAMA Dermatology (see New Finding “Combination Treatment Is a New Approach for Difficult-to-Treat Vitiligo”.)

Warts

Common warts, foot warts (also called plantar warts), and flat warts are all noncancerous growths caused by a virus in the human papillomavirus, or HPV, family. They can develop almost anywhere on the body and are usually the color of your skin.

Common warts are more likely to appear on the hands, especially where the skin has been broken. Foot warts develop on the soles of the feet, but do not usually grow out of the skin because the pressure of walking pushes them back into the bottom of the foot.

Flat warts are smooth and small, but as many as 100 can develop in a single area. They often occur on the face in older men and on the legs of women. The warts may be associated with shaving those areas, but scientists have been unable to prove that theory.

Small Risk of Transmission

Warts can be transmitted from one person to another, but the risk is small. The time between contact with another person and developing a wart is several months. Contact does not have to be direct, either. Sharing towels and other items with someone who has warts could facilitate the virus’s transfer. Some warts go away on their own, while others have to be removed because they cause a problem.

Remove Them Only If….

Warts should be removed only if they are unsightly, painful, or bleeding. One home remedy is to apply salicylic acid (contained in the over-the-counter product Compound W) to warts on the hands, feet, or knees. The acid has to be applied every day for several weeks.

A doctor might apply a chemical called cantharidin to destroy the wart. A second visit is needed to remove the dead skin. Dermatologists also use liquid nitrogen to freeze a wart, and two to four treatments over a period of several weeks are necessary to remove the growth. Immunotherapy, laser therapy, and injecting each wart with an anticancer drug called bleomycin are used less frequently than more conservative methods.

Warts can reappear almost as fast as existing ones go away, probably because the virus is still present in the general area. The only way to deal with this problem is to treat the new growths as soon as possible to prevent the leftover virus from infecting nearby skin.

Wrinkles

Wrinkles are a fact of life—or more specifically, a fact of aging—but they can be more pronounced and develop earlier among people who smoke, are over-exposed to sunlight, exposed at all to indoor tanning, or are chronically dehydrated.

Even facial expressions can lead to fine lines. Young skin springs back; older skin, not so much. Wrinkles will appear most often in parts of the body that are frequently exposed to sunlight—face, neck, hands, and arms.

Hundreds of products, as well as clinical procedures, have made their way to the market. Some work; some don’t. Here’s a 2018 update on what the evidence says.

Over-the-counter creams: Ingredients include retinol, vitamin C, hydroxy acids, peptides, coenzyme Q10, and others. Effectiveness, according to the Mayo Clinic, depends in part to which ingredient is included. Most contain lower concentrations of prescription medications. No single product works for everyone. Results, if any, are modest and short-lived.
Prescription medications: Retinol is one of the most common prescription ingredients. According to the Harvard Medical School, retinol reduces fine lines and wrinkles by increasing the production of collagen. It takes three to six months of regular use before improvement is apparent, and the medication must be used continually to maintain its benefits.
Dermabrasion: Dermabrasion, says UCLA Health, involves using a high-speed rotating brush to remove the top layer of skin. The degree of wrinkling determines the appropriate level of skin that will be removed. Results could take several months and are temporary.
Laser resurfacing: Laser resurfacing removes or softens wrinkles. It provides controlled shedding of damaged skin, which exposes a new layer of skin, according to the American Academy of Facial, Plastic, and Reconstructive Surgery. It also stimulates new cell growth. Results are not guaranteed and depend on multiple skin-related factors.
Radiofrequency: Radiofrequency energy is used to tighten the skin and reduce wrinkles. The AAD reports that noticeable skin tightening starts to occur within one month of treatment, with best results visible in four months.
Chemical peel: A chemical peel uses a solution to improve the skin’s appearance by removing the damaged outer layers according to UCLA Health. The healing process takes from one day to three weeks, depending on the type of peel. Possible side effects are redness, scarring, changes in skin color, and infection. It is not for everyone.
Botox: Botulinum toxin (Botox, Dysport) was approved by the FDA for the treatment of wrinkles in 2013. It temporarily paralyzes muscle tissue to reduce the appearance of wrinkles. A 2016 study published in the Journal of Clinical and Diagnostic Research found that treatment with botulinum toxin is a simple, safe, and effective way to reduce forehead wrinkles. Results last up to four months.
Soft tissue fillers: Soft tissue fillers, according to the American Society for Dermatologic Surgery, contain some form of hyaluronic acid, which occurs naturally in the body. The results depend on location and depth of the wrinkles. The effect on reducing wrinkles lasts 6-24 months.

Prevention

Prevention measures will look familiar: Limit your exposure to sunlight, use broad-spectrum sunscreens with a SPF of 30 or more, apply moisturizers, don’t smoke, and eat lots of fruits and vegetables.

The post 4. Noncancerous Skin Conditions appeared first on University Health News.

3. Other Skin Conditions

JoAnn Milivojevic — Mon, 20 Nov 2017 19:11:24 +0000

Imagine that you have been offered a promotion. You work for a company that manufactures one of the most complex, sophisticated products known to man. The product weighs about six pounds and covers 20 square feet. It has multiple functions, millions of moving parts, can easily be damaged, and has to be renewed from within about every four weeks.

One other thing: This miracle product, over its lifetime, is going to be outside for extended periods of time. It will be subject to temperature and humidity extremes, sun, wind, rain, dirt, dust, and other external forces that could affect its proficiency and longevity.

Your new position, should you accept it, will be to assume total responsibility for this product—protect it, clean it, maintain it, make it look presentable, and see that it operates efficiently for as long as you live. Would you accept that responsibility? You really don’t have a choice, and you know where this has been going. The product is your skin, and the information above is not fake news. It’s a fact.

Among the infinite number of conditions that could do harm to your skin are the 25 discussed in this chapter. They range (alphabetically) from aging skin to minor wounds.

Now the question is: What are you going to do about it?

Aging Skin

Let’s begin with the good news. Two studies, one published in 2016 and one in 2017, are thought to be ground-breaking in terms of laying the foundation for developing anti-aging products for the skin.

The first was conducted at Newcastle University in the UK, where a research team identified an enzyme in skin cells that declines with age. Now that a specific biomarker has been targeted, scientists can begin to develop anti-aging treatments and creams to counter this aspect of the aging process (see Box 3-1, “British Scientists Identify a Key Skin Cell Enzyme That Declines With Age”). At the University of Pennsylvania, researchers learned that adult stem cells collected directly from fat tissue are more stable than other cells, are more robust, and also have the potential for use in anti-aging treatments (see Box 3-2, “Stem Cells Collected From Fat May Be Useful as Anti-Aging Treatments”).

Although both studies have the potential to change the way aging skin is treated or its progress slowed down, the key word is “potential.” Until new products based on these discoveries are available for consumers, there are plenty of ways to delay or moderate the aging process.

Signs of Aging Skin

Too much exposure to sunlight can accelerate the process of aging skin. The U.S. National Library of Medicine (nlm.nih.gov) provides the following list of aging skin characteristics:

Skin appears to be thinner, paler, and translucent.
Skin’s strength and elasticity diminishes.
Blood vessels become fragile, making it easier to bruise and bleed.
Sebaceous glands produce less oil, resulting in dryness.
The fat layer becomes thinner, leading to less padding and insulation.

The rate of change varies because of genetic factors. Most people can delay the changes by preventing sunburn, using quality (SPF 30+) sunscreens, wearing protective clothing, using moisturizers, and staying hydrated.

The first noticeable sign of aging skin is wrinkles. Wrinkles develop when collagen and elastin, the two components that maintain skin firmness, begin to weaken. Instead of remaining thick and tight, the skin becomes thin and loose. Coarse wrinkles are more likely to appear on the forehead, outer corners of the eyes, and around the mouth. Fine wrinkles appear in areas of facial movement, like the eyes, mouth, and upper lip.

Natural Aging Conditions

Other natural aging conditions include thinner and more transparent skin, the loss of fat underneath the top layers of skin, sagging skin due to bone loss, dry skin, easily bruised skin, difficulty in cooling the skin by perspiration, hair that turns gray or white, loss of hair, and unwanted hair (in the outer ears, for example).

The genetic component is why some people get gray hair in their 20s, or begin to lose their hair earlier than others. Box 3-3, “Skin Changes and Possible Causes,” lists some skin changes that can occur with age. Gravity’s effect on the skin is an example of external skin aging.

Skin elasticity declines dramatically during a person’s 50s. The tip of the nose might droop, earlobes get longer, eyelids seem to fall, jowls develop, and the upper lip tends to disappear while the lower lip is more pronounced. It is not comforting, but it’s normal.

Sleep lines can result from lying in the same position every night and resting the face the same way on the pillow, according to the American Academy of Dermatology (aad.org). These wrinkles eventually become part of the face’s landscape, even when not sleeping. Women tend to get them on their cheeks and chin, while men are more likely to see them on their forehead. The solution, if it is not too late, is to sleep more on your back to prevent the skin from bunching up against a pillow.

Smoking Accelerates the Process

People who smoke at least 10 cigarettes a day for 10 years are more likely than nonsmokers to develop wrinkles. Smokers’ skin also may have a yellowish hue. Although wrinkles in the face are not visible until later in life, they can be seen under a microscope in smokers still in their 20s. It’s never too late to quit smoking and to reverse, or at least slow, the wrinkling process.

Age Spots

Age spots are caused by long-term exposure to the sun. They are larger than freckles and often appear in older adults on the face, hands, arms, back, and feet. They may be accompanied by wrinkling, dryness, thinning of the skin, and rough spots. Several over-the-counter products claim to fade age spots, but a prescription drug recommended by a dermatologist and used for several months is more likely to provide lasting results. The most widely prescribed treatments are hydroquinone and tretinoin.

Itching, Flaking

Aging and drying skin can cause itching and flaking, especially for those who live in cold, dry, or windy areas. Moisturizers applied right after bathing can minimize dry skin. Some moisturizers contain chemicals (urea, alpha-hydroxy acids (AHA), lactic acid, and ammonium lactate) that reduce scaling and assist the skin in holding water. However, they can irritate the skin. Ask your dermatologist for help deciding which moisturizer is best for your age and skin type.

Photoaging

By far the most damaging external aging factor is the sun. Relatively little exposure can cause freckles, age spots, leathery skin, wrinkles, loose skin, a blotchy complexion, reddish patches, and skin cancer, says the AAD.

Photoaging is the technical term for exposure to the sun. Both skin color and the length of long-term exposure determine the amount of photoaging. The skin normally can heal itself after overexposure, but it loses that ability with age. The damaging effects appear at a much earlier age if you do not protect your skin. Photoaging is visible using special cameras years before it becomes apparent to the person.

Injections, Topical Solutions

Hyaluronic acid is one of many substances applied on top of the skin or injected to lessen the effects of wrinkles, dark spots, fine lines, and other age-related skin conditions. Injections with dermal fillers that contain hyaluronic acid may stimulate the production of collagen, a protein that can partially restore the structure of skin damaged by sunlight. The injections, in effect, stretch the cells and allow the collagen to fill the space.

Topical retinol is another option. Non-commercialized lotions containing retinol appear to reduce wrinkles, roughness, and overall aging severity. Retinol, as well as carbon dioxide laser resurfacing (which uses high-intensity light to rejuvenate wrinkled skin), improves overall skin appearance by stimulating the production of collagen. One study found that “wrinkle scores” improved by up to 45 percent among a group of patients who underwent carbon dioxide laser resurfacing.

Other possible treatments include alpha-hydroxy acids (AHA) and botulinum toxin (Botox, Dysport). AHA, derived from fruit and milk sugars, are contained in many cosmetics. However, although these products are safe in most cases, the FDA has received reports from consumers regarding adverse reactions, including redness, swelling around the eyes, burning sensations, blistering, bleeding, rashes, itching, and skin discoloration. A study published in JAMA Facial Plastic Surgery found that skin pliability and elasticity improved after treatment with Botox, but the benefits only lasted up to four months.

Box 3-4, “Skin Care Ingredients,” lists these and other selected skin care substances, how they are administered, and the problems they target.

Illness-Related Skin Care

The American Geriatrics Society (americangeriatrics.org) offers a list of basic skin care tips for older Americans who have age-related skin conditions or illnesses. Some of the suggestions reinforce basic tips described here and in Chapter 2, some have a slightly different approach or emphasis for this age group, and some apply only to those who have a specific skin condition or disease.

Dry Skin

Aging skin also makes other common problems more frequent, like dry, itchy skin and fungal infections. Here are some tips for how to prevent and treat them:

After a shower or bath, pat your skin gently with a towel, but leave the skin moist. Then apply a lotion, body oil, or moisturizer that is high in petroleum jelly (Aquaphor or Eucerin).
Take fewer showers and baths, and use good bathing techniques. Do not roughly scrub the skin. Use a sponge instead of a washcloth. Use a soap containing glycerin or one that has a moisturizing cream, like Dove or Tone.
Change bed sheets and clothing often. Wash clothes and sheets in detergents free of perfumes and fabric softeners that could irritate the skin.
Drink lots of fluids, and minimize caffeine and alcohol.
Use a humidifier to keep the air moist. Change the water every day to prevent the growth of bacteria.

Fungal Infections

Keep skin clean and dry.
Change socks and shoes once a day.
Wear loose clothing.
Use antifungal powders or creams, such as clotrimazole (Lotrimin) or miconazole (Micatin).

A Message for Older Adults

Aging skin loses its ability to repair sun exposure damage. Also, cumulative light damage results in thin, damaged skin that worsens with additional exposure. Older adults have skin that is less effective at sweating and cooling, so they should always wear tightly woven clothing that covers exposed skin surfaces. They should also plan outdoor activities when the sun is not directly overhead and the air is cooler.

Even driving habits can increase the risk of sun damage. Skin cancers develop predominantly on the left side of drivers—the side more likely to be exposed to the sun while driving.

Boils

Common sites for boils are the face, neck, armpits, buttocks, groin, and thighs. They begin as a red, elevated, warm, and painful bump on the skin, which is often caused by an infected hair follicle. A foreign object imbedded in the skin, a plugged sweat gland, or blocked oil duct also can trigger boils.

Heat First

Do Not Lance

Prevention

There are no guarantees that the safety precautions in Box 3-5 will keep you from getting a boil, but you can at least lower your risk and possibly prevent other skin problems.

Calluses and Corns

Although calluses and corns may require attention, neither is a serious problem. Both are areas where the skin has hardened and thickened, and are caused by pressure or friction. Both can develop on the hands or feet, but neither is likely to cause pain or tenderness.

Calluses can be more than an inch in diameter. They can develop under the big toes, balls and heels of the feet, on the knees, and on the hands, often at the base of the fingers. Calluses can actually protect hands and feet under conditions that involve constant friction, such as gardening and playing sports.

Corns are smaller than calluses and can have either a hard or soft center. The most likely spot for a soft corn is between the toes, but a hard corn may develop on the top or outer sides of the toes.

Treatment

Neither condition needs treatment unless it causes pain. One way to treat corns and calluses is to avoid the contact that causes the friction, or in the case of the hands, to wear protective gloves. Another option is to relieve the pressure by using a doughnut-shaped pad on the foot, and a third is to soften the area with an over-the-counter salicylic acid product before removing the dead skin. In rare cases, surgery is needed to remove a corn or callus.

You should not cut a callus or corn, especially if you have diabetes or any other condition that affects circulation, but you can gradually wear down the area with a pumice stone.

Prevention is always better than treatment. Steps you can take to reduce your risk include not wearing tight, high-heeled, or loose-fitting shoes, or socks that do not fit. Walking barefoot can also cause calluses and should be avoided when doing so is the cause. See Box 3-6, “Treating Corns and Calluses,” for American Academy of Dermatology suggestions.

Cysts

Several terms are used to describe small, fairly common cysts that develop just below the surface of the skin. The National Institutes of Health refers to them as epidermal cysts.

Cysts can be moved around (under the skin) within a small area. They do not hurt, and they do not grow at a quick pace, but they can become tender, inflamed, and perhaps larger than when you first noticed them. Typical epidermal cysts range in size from one-quarter inch to two inches. When inflammation is involved, cysts are likely to be tender and red, and the temperature of the skin on top of the growth may rise.

Don’t Worry Unless….

Dermatitis

A third form is called atopic dermatitis (atopic eczema), which is a condition passed from parents to children that can develop at any time during a person’s life, but it is primarily a problem for infants and children. Corticosteroids are still the treatment of choice, but the FDA has approved newer, effective gels, foams, and oils.

In March 2017, the FDA approved dupilumab (Dupixent) in injection form to treat adults with moderate-to-severe atopic dermatitis. Dupixent is intended for patients whose eczema is not controlled by topical drugs or those for whom topical therapies are not advisable. Dupilumab can be used with or without topical corticosteroids.

Allergic Contact Dermatitis

Drugs may cause problems themselves. Neomycin, a commonly sold over-the-counter topical antibiotic, and formaldehyde are two examples.

A third is one not familiar to the average consumer: alkyl glucoside. It was named “Contact Allergen of the Year” in 2017 by the American Contact Dermatitis Society. The substance is found in household products such as cosmetics, cleansing agents, fragrances, and tanning creams. It is also a “hidden” allergen in the sunscreen ingredient tinosorb M (Bisotrizole).

Irritant Contact Dermatitis

Treatment

Diabetes-Related Conditions

A third of people who have diabetes will experience a diabetes-related skin problem. Sometimes the skin disorder is the first sign that diabetes is present. Diabetes and skin issues are directly linked. The warm, high-sugar content of the body’s blood is a perfect environment for the growth and development of skin-related bacterial and fungal infections. Anyone can get these skin conditions, but diabetics are more susceptible.

A common symptom of many diabetes-related skin diseases is itching (also called pruritus). It can be caused by a variety of issues, including dry skin, yeast infections, or diminished blood flow to an area of the skin. Lower legs are affected more often than other regions of the body. Lotions and moisturizers can limit itching by keeping the skin soft and moist, but excessive amounts applied to certain areas create an environment conducive to infections.

The American Academy of Dermatology offers 12 warning signs of diabetes that appear on the skin (see Box 3-7, “12 Skin-Related Warning Signs of Diabetes”).

Bacterial Infections

Styes, boils, carbuncles (cluster of boils), and nail infections are examples of bacterial infections that can occur in people with diabetes. The symptoms are hot, swollen, red, and painful spots, depending on the condition (styes on the eyelids; boils around hair follicles; carbuncles deep in the skin; nail infections on hands or feet). The most common type of bacterial infection is staphylococcus, or “staph,” for short.

Fungal Infections

Athlete’s foot, jock itch, ringworm, and some vaginal infections are fungal infections that affect the general population, but which present special problems for people with diabetes. The cause is often candida barbicans (CA), a yeast-like fungus that targets diabetics. It causes an itchy, red area surrounded by small blisters and scales, usually in warm, moist folds of the skin, such as the mouth, vagina, breasts, fingers, toes, nails, and rectum. CA can move through the bloodstream and affect other areas of the body.

Other Conditions

Diabetic dermopathy, necrobiosis lipoidica, diabetic blisters, and eruptive xanthomas are either specific to people who have diabetes, or occur most frequently in those who have it.

Diabetic Dermopathy

Necrobiosis Lipoidica (NL)

Diabetic Blisters

People rarely develop diabetic blisters on their fingers, hands, toes, feet, legs, or forearms, but it can happen. They resemble blisters caused by burns, but are not painful. Diabetic blisters heal in two to three weeks without treatment. Those who develop the blisters often suffer diabetic neuropathy, a nerve disorder caused by diabetes. The only way to guard against the incidence of diabetic blisters is to keep blood sugar levels under control.

Eruptive Xanthomas (EX)

Prevention

The AAD suggests the following measures to prevent or reduce the risk of diabetes-related skin diseases:

Keep skin clean and dry by using talcum powder where skin touches skin.
Avoid hot baths and showers, and do not put lotion between your toes. Warm, moist surfaces are breeding grounds for infections.
Prevent dry skin by using moisturizers, especially in cold, windy weather.
Treat cuts immediately. Wash them with soap and water, but avoid products that are too harsh, such as alcohol and iodine.
Use antibiotic cream only if advised to by your doctor.
Keep your home more humid than normal during cold, dry months.
Bathe less, if practical.
Use mild shampoos, and avoid feminine hygiene sprays.
See a dermatologist for skin conditions you cannot treat.

Folliculitis

Hair follicles damaged by friction, blockage, or shaving can become infected with the staphylococcus (staph) bacteria. Symptoms include a rash, itching, or pimples on the neck, groin, or genital area. Your doctor may be able to diagnose folliculitis with a visual exam. Lab tests show the type of disease agent that has caused the infection. Hot, wet compresses can help drain the area, and treatment may include oral or topical antibiotics. The condition is easy to treat, but it may recur and the infection can spread to other areas of the body. If self-care does not relieve symptoms within two or three days, contact a medical professional.

Herpes Simplex

The herpes simplex virus (HSV 1) causes cold sores and blisters around the mouth. The sores may sting, burn, tingle, or itch. (A different kind of herpes virus—herpes zoster—causes chickenpox and shingles, and herpes simplex type 2 causes genital herpes.)

Hives

A person most likely to suffer from hives has had a previous episode, tends to have allergic reactions in addition to those resulting in hives, has a family history of hives, or has a non skin-related disorder such as lupus, lymphoma, or thyroid disease.

Acute Hives

Chronic Hives

Treatment Goal: Relieve the Symptoms

Over-the-counter (OTC) antihistamines like Benadryl, Chlor-Trimeton, Zyrtec, Tavist, and Claritin counter the effects of the histamine produced by the body, as can prescription drugs, such as hydroxyzine (Atarax, Vistaril), desloratadine (Clarinex), fexofenadine (Allegra), levocetirizine (Xyzal). These medications may be taken in combination with drugs known as histamine-2 (H2) blockers, like Zantac and Tagamet.

The corticosteroid prednisone, when taken orally, might control hives, but it is seldom recommended because of its side effects, such as fluid retention, increased blood pressure, and elevated pressure in the eyes.

Keep a Food Log

Avoiding the substances and environments that causes hives is the best way to prevent them, but it is not always that easy. If you think foods are the problem, keep a log to detect problem items or ingredients they might contain. Foods that can be associated with hives include:

Eggs
Milk
Nuts
Fish
Berries
Chocolate
Tomatoes

Impetigo

Impetigo is a common, contagious skin condition seen most often in children, but it can develop in adults who have had other skin disorders, colds, or upper respiratory infections. It is caused by a bacterial infection that produces crusty skin lesions that itch first and ooze later. A doctor often can diagnose impetigo simply by looking at it.

Antibacterial creams are effective for mild infections, but more severe cases require oral antibiotics. The lesions seldom leave scars, even though they are slow to heal. Prevent the spread of impetigo: Use clean washcloths and towels, and do not share towels, clothing, razors, or any similar items with friends or family members.

Lupus

Lupus can affect anyone at any age, but women get it more often than men. It is diagnosed between ages 15 and 45 and is more common in Asians and blacks than in other ethnic groups.

Symptoms and Diagnosis

Treatment

If and when lupus is diagnosed, treatment includes rest, exercise, physical therapy, and medications—NSAIDs, steroids, antimalarial drugs, and drugs that suppress the immune system. It is important for a person who has lupus to avoid exposure to sunlight and UV rays emitted indoors by fluorescent and halogen lights.

Moles

Most people have between 10 and 40 moles on average, and their presence was probably determined at birth. They can develop on any area of the body, including the scalp, between fingers or toes, and under fingernails and toenails. The number of moles can change with age, with some fading as a person moves into adulthood, while others disappearing altogether or lasting 50 years or longer. Sunlight can increase the number of moles and make them darker.

Most moles are harmless and will never be a health threat, but in some cases they may lead to a higher risk of certain cancers (see Box 3-8, “Differences Between a Common Mole and Melanoma”). Traditionally, people who had the greatest number of moles were thought to have a greater risk of developing a melanoma. However, a recent study in JAMA Dermatology suggested that physicians should not rely on the total number of moles as the only reason to perform an exam or determine a patient’s risk.

Tell Your Doctor If . . . .

The National Cancer Institute says to tell your doctor if you notice any of the following changes in a common mole:

The color changes.
The mole gets unevenly smaller or bigger.
The mole changes in shape, texture, or height.
The skin on the surface becomes dry or scaly.
The mole becomes hard or feels lumpy.
It starts to itch.
It bleeds or oozes.

Mole or Melanoma? A Gene May Disclose the Answer

A biopsy can determine if it is malignant, and a mole can be removed by shave excision (using a small blade to cut it out), punch biopsy (removing the mole with a small device that works like a cookie cutter), and excisional surgery (which involves taking out the mole and the skin around it). All of the procedures can be performed in a dermatologist’s office. Once removed, most moles do not recur. If one does, let your doctor know.

Methicillin-Resistant Staphylococcus Aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) is a potentially dangerous staph bacterium that is resistant to certain antibiotics. It may cause skin and other infections throughout the body. The bacterium is carried by 2 percent of the population, but few are infected. Those who have weak immune systems are most vulnerable, especially those in hospitals, nursing homes, and other healthcare facilities. The symptoms of MRSA may include a fever, and a bump or infected area of the skin that has one or more of the following conditions:

Red, swollen
Painful, warm
Filled with pus

MRSA is spread by direct contact, sharing personal items, and touching surfaces or items contaminated with MRSA.

Treatment

Treatment may involve draining the infection and taking an antibiotic, and it is important to continue taking the medication even if the infection appears to get better. Oritavancin is given in a single dose and may become an option for the treatment of MRSA, and other skin infections.

Researchers in Los Angeles have challenged the current Centers for Disease Control and Prevention (CDC) strategy for dealing with MRSA in hospitals, which stresses limited contact between patients and staff. Their research showed that bathing patients in a common hospital soap called chlorhexidine was just as effective as limiting contact, and could result in better quality of care because of increased contact.

In 2016, researchers in Oklahoma developed a new antibiotic to treat MRSA. The formula uses an antibiotic/polymer formulation and awaits FDA approval. The approach restores efficacy to obsolete antibiotics. The use of first-line antibiotics to kill MRSA and other infectious bacteria may improve patient outcomes and lower hospitalization costs.

Prevention

The best ways to prevent MRSA are:

Know the signs.
Get treatment early.
Practice good hygiene, especially by washing hands often.
Do not share personal items, such as towels and razors.
Follow prescription drug instructions precisely and complete the prescribed course, even if symptoms subside.

Take (all of) Your Medicine

A 2016 study found that patients with certain skin infections took, on average, only 57 percent of their prescribed antibiotic doses after leaving the hospital. Nearly half of 87 patients developed a new infection or needed additional treatment for the existing skin condition. The findings suggest that better methods are needed to inform patients about the importance of adhering to prescription instructions, or that newer antibiotics are needed that require only once-a-week doses.

Poison Ivy, Poison Oak, Poison Sumac

Poison ivy, poison oak, and poison sumac contain the oil urushiol, which can cause an allergic reaction in the form of a blistering rash and serious itch. In most cases, they can be treated at home. But if you have any of the following symptoms, the American Academy of Dermatology recommends that you go to an emergency room immediately:

Trouble breathing or swallowing
A rash that covers most of your body
Multiple rashes and blisters
Swelling, especially if an eyelid swells and shuts
A rash on your face or genitals
Home remedies do not ease the symptoms.

The home treatment for exposure to the three plants is the same (see Box 3-10, “Poison Plants: Home Remedies”).

Protect Yourself

The best way to protect yourself from an allergic reaction caused by poison ivy, poison oak, and poison sumac is to recognize them (see Box 3-11, “Poison Ivy, Poison Oak, Poison Sumac”) and stay away from them.

Psoriasis

Even though psoriasis affects up to 8 million people in the United States, about 40 percent of psoriasis patients do not get treatment. For older adults, peak onset occurs between ages 50 and 60. There are five types of psoriasis, and each has unique symptoms, but 80 percent of people get the most common variety: plaque psoriasis.

Approximately one-third of psoriasis patients have a family history of the disease. It occurs when T-cells that normally protect the body against infection and disease develop and rise to the surface at a faster-than-normal rate (see Box 3-12, “How Psoriasis Develops”). They accumulate on the top layer of skin before they have time to mature.

Skin cell turnover usually takes about a month, but in psoriasis it can happen in a few days. This process results in patches of thick, inflamed skin covered with scales that itch and can hurt.

Symptoms Come and Go

Excessive inflammation is a critical feature, and since it is also a characteristic of insulin resistance, obesity, high cholesterol levels, and cardiovascular disease, psoriasis patients should consult with their healthcare providers to watch closely for signs of these conditions.

Scientists in Germany have developed a tissue scanner that allows doctors to look under the skin of psoriasis patients. The device provides information about the structure of skin layers and blood vessels without the need for contrast agents or radiation exposure. The device was introduced in Nature Biomedical Engineering (May 2017).

Three Treatment Steps

Physicians often use a three-step treatment approach, which includes topical medication, phototherapy, and oral or injectable drugs.

Step 1

Prescribe or recommend a topical medication, which could include any of the following substances:

Corticosteroids to reduce inflammation and slow cell turnover.
Calcipotriene is a synthetic form of vitamin D used to limit cell production.
Retinoids are synthetic forms of vitamin A that normalize DNA activity in cells.
Moisturizers reduce itching, scaling, and drying.

Combinations of topical drugs are more effective than any single topical application alone.

Step 2

Photodynamic therapy, or the use of natural or artificial ultraviolet (UV) light. When UV light is absorbed into the skin, it can affect the production of T-cells and slow the rate of turnover that causes the scaling effect. However, overexposure can make symptoms worse and damage the skin. Talk with your doctor about the safest use of natural sunlight. Phototherapy can also be combined with other therapies, such as application of a retinoid substance or coal tar ointments.

Step 3

Take oral or injectable drugs to treat the body’s entire immune system (called systemic therapy). Drugs used to treat more severe forms of psoriasis may produce serious side effects, such as nausea, dizziness, bruising, fatigue, and kidney malfunction.

Methotrexate suppresses the immune system.
Retinoids are used when other treatment fails.
Cyclosporine suppresses the immune system.
6-Thioguanine suppresses the immune system.
Hydroxyurea is sometimes combined with other treatments.
Biologics are drugs made from human or animal protein that block the effects that cause inflammation.
Antibiotics are used to eliminate infection-causing bacteria.

Biologics

Biologics include Alefacept (Amevive), etanercept (Enbrel), adalimumab (Humira), efalizumab (Raptiva), and infliximab (Remicade). These drugs, according to the National Psoriasis Foundation, are better at targeting overactive immune cells (specifically, T-cells), and produce fewer side effects than other psoriasis drugs. Some dermatologists now consider biologics as a first-line treatment.

Biologics have to be administered by injection or by intravenous infusion. The latter can take up to two hours. They appear to be a safe treatment option for people with psoriasis and psoriatic arthritis, but their long-term effects are not known. Also, they should not be prescribed for a person who is already taking another drug that suppresses the immune system.

Two biologic drugs, secukinumab (Cosentyx) and ixekizumab (Taltz), had previously been approved by the FDA to treat psoriasis. A third drug, brodalumab (Siliq), was approved in February 2017 to treat adults with moderate-to-severe plaque psoriasis (see Box 3-13, “FDA Approves Brodalumab to Treat Psoriasis”).

Other Drugs

A class of diabetes drugs known as thiazolidinediones (TZDs) may reduce your risk of psoriasis. A drug (alefacept) that reduces the activity of immune cells is effective for the treatment of scalp psoriasis. And low-dose treatment with acitretin may minimize the effects of nail psoriasis.

Treating Psoriasis at Home

Treating yourself can be time-consuming and frustrating, but there are ways to do it. The AAD offers self-care tips; see Box 3-14. Also, the Mayo Clinic suggests several strategies for dealing with psoriasis in lifestyle and health-related decisions. They include the following:

Daily baths to remove scales and reduce inflammation, but avoid hot water and harsh soaps.
Use moisturizers to prevent drying of the skin.
Cover affected areas at night with moisturizers, and lightly cover with plastic food wrap.
Use cortisone to reduce inflammation; try over-the-counter creams with 0.5 to 1 percent cortisone.
Avoid triggers such as stress, smoking, excessive sun exposure, and drinking alcohol.

Psoriatic Arthritis (PA)

Approximately 15 percent of people who have psoriasis also develop psoriatic arthritis, which is a form of inflammatory arthritis. The symptoms vary widely and make it difficult to diagnose, even for physicians. X-rays, joint fluid tests, and blood tests are used to make a diagnosis.

Treat the Symptoms

The goal of treatment is to suppress symptoms rather than cure the disease. Doctors first try nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen.

The FDA has approved the drugs golimumab (Simponi) and ustekinumab (Stelara) for the treatment of psoriatic arthritis. They also approved a new drug called apremilast (Otezla) to treat psoriatic arthritis by blocking enzyme-related inflammation.

A rheumatologist should treat psoriatic arthritis if arthritis is the focus. If the primary symptoms involve only the skin, a dermatologist should treat them.

Rosacea

Two facts about rosacea stand out: 1) more than 16 million people in the U.S. have the condition; and 2) most of them do not even know it. Rosacea has been classified into four subtypes, which are described by the National Rosacea Society (see Box 3-15 “Rosacea Subtypes and Symptoms”).

Primary Targets

Individuals most susceptible to the condition have fair skin, blush easily, are between ages 30 and 60, and have a family history of the condition. Women are affected more often than men, but that may be because men wait longer to seek treatment.

Unknown Cause

Some experts theorize that rosacea is caused by a disorder of the blood vessels, skin mites, a fungal infection, a malfunction of the connective tissue under the skin, or unspecified psychological factors.

Family History

Rosacea has psychological as well as physical consequences. A 2014 survey conducted by the NRS found that more than 75 percent of patients said their condition lowered their self-confidence and self-esteem. Fifty-two percent said it was the reason they avoided public contact and cancelled social engagements.

Increased Risk of Three Cancers

If rosacea is not treated, it always gets worse, and sometimes progresses into a more serious condition called rhinophyma, which affects the nose, giving it a red, bulbous appearance. Almost 90 percent of rosacea patients say their condition is under control with treatment. Treatment varies, depending on which symptoms are targeted, and usually consists of a combination, targeted approach.

Oral and Topical Medications

Topical medications include azelaic acid, benzoyl peroxide, clindamycin, erythromycin, metronidazole, sulfacetamide, and sulfur lotions. Keep in mind that it might take two or three months to get significant results. The AAD issued a statement in 2014 acknowledging that skin prone to acne or rosacea may improve with daily probiotic use.

Pimples and bumps may respond better to oral antibiotics, including doxycycline, erythromycin, minocycline, and tetracycline.

Avoid Triggers

Rosacea cannot be prevented, but the symptoms can be controlled once they have developed. The first step is to avoid possible triggers. Box 3-16, “Rosacea Triggers by Percent Affected,” shows the results of a survey taken by the NRS of more than 1,000 patients regarding factors that produce an episode.

Scabies

Seborrheic Keratosis (SK)

Seborrheic keratosis (SK) looks like a wart-like tumor on the surface of the skin and may be mistaken for skin cancer. It is neither, but SK is a common skin growth in older adults.

SK can appear alone or in clusters, have a rough or smooth texture, and do not penetrate deeply into the skin. They can be quite small or more than one inch in diameter, and are painless. However, rubbing or scratching can cause inflammation.

Not Contagious

Descriptions of SK include the term “stuck on” or “pasted on,” as if someone dabbed a patch of candle wax onto the skin. They are not contagious, but they do seem to run in families.

The American Academy of Dermatology says exposure to sunlight does not seem to be a cause or a complicating factor after SK has developed. However, the Mayo Clinic believes exposure to sunlight may be a factor because the condition is common in areas often exposed to the sun.

Unsightly, Not Dangerous

Also, do not waste your money on creams, ointments, or other over-the-counter products that claim to remove the growths. They don’t work.

Shingles

The same virus that causes chickenpox (herpes zoster) causes shingles. In fact, people who get chickenpox as children retain the dormant virus in nerve cells. Later in life, the virus can re-emerge for unknown reasons.

Shingles itself develops only from a reactivation of the virus in someone who previously had chickenpox. Those who are most susceptible are age 60 and older, are under stress or ill, and have a weakened immune system because of age, disease, or medications. Family history also might make a person more susceptible to shingles.

Not Contagious, but …

Shingles is not contagious, but the virus that causes it can be spread by direct contact from a person who has the condition to another person who has not had chickenpox. That person will get chickenpox, but not shingles.

The two distinguishing symptoms of shingles are a skin rash and pain. The rash usually develops in a band-like pattern on one side of the body, and can appear anywhere on the body, including the torso, limbs, and face. It lasts two to four weeks.

The first sign may be a burning or tingling sensation, itching, or numbness. After a few days, a rash of blisters filled with fluid may appear as a band covering one side of the trunk from the back to the front of the body and downward to the waistline, but shingles can also affect the face and eyes.

Pain Level

The pain associated with shingles can be mild or severe, but do not underestimate its severity when people complain about it. The slightest touch or contact can cause excruciating pain.

The blisters often last a week to 10 days, then form a crust and fall off. In some cases, this process can take three to five weeks. The skin may change color (darker) once the rash subsides. Although the rash improves, the pain can last longer.

Twenty percent of those who get shingles develop a condition known as postherpetic neuralgia (PHN)—nerve pain without the rash that can persist for years. The older you are when you get shingles, the more likely you are to develop PHN. The main symptom is pain so severe that it can cause insomnia, weight loss, and depression.

A study published in PLOS Medicine found that a shingles episode increases the short-term risk of stroke and heart attack, but the risk decreases over the following six months.

Relief

There is no cure for shingles, but the symptoms can be reduced by taking antiviral drugs, such as acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). Other medications used to treat symptoms are steroids, anticonvulsants, antidepressants, and over-the-counter pain medications, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). A medicated lotion such as Benadryl or Caladryl might reduce the pain and itching, as will cool compresses soaked in an astringent liquid (Bluboro, Domeboro).

Although shingles is incurable, it may be preventable. The CDC recommends that adults older than age 60 get a single dose of the shingles vaccine Zostavax, which has been approved by the FDA.

People older than age 60 who get the shingles vaccine have a 50 percent reduced risk of getting the condition. In those who are infected despite the shots, the severity and complications (including postherpetic neuralgia) are reduced.

A study of more than 190,000 adults older than age 50 found that the shingles vaccine is safe and has few side effects. The vaccination does not, contrary to some reports, increase the risk of heart disease, stroke, infection of the brain, Bell’s palsy, or Ramsay-Hunt syndrome.

One exception to getting the vaccine is people who have a weakened immune system. Ask your doctor if a vaccination is appropriate for your age and medical condition.

Skin Tags

A tag sticks out of or looks like it is hanging from the skin, usually near the neck, armpits, trunk, breasts, or other areas of the body where the skin folds. Some may be darker than the skin color.

Skin tags occur in approximately 46 percent of the population, and the incidence increases with age. The number goes up to 59 percent by the age of 70.

Linked to Metabolic Syndrome

They appear to have an association with metabolic syndrome (a group of risk factors associated with diabetes and stroke that include a large waistline, high triglycerides, low HDL cholesterol, high blood pressure, and high fasting blood sugar). There is some evidence that susceptibility may be genetic.

Skin tags do not grow (they are usually just a fraction of an inch in diameter), they do not hurt, and they are not a form of skin cancer. The only potential problems are 1) they are not attractive and 2) they can become irritated if clothes or jewelry rub against them. They also may develop because of skin rubbing against skin, and are more common in those who are overweight or have diabetes. Unusually large tags may burst and bleed under pressure.

Easy to Diagnose and Treat

The National Institutes of Health do not recommend that a person attempt to remove a skin tag without medical assistance because of the risk of bleeding and infection. Over-the-counter products are available, but not recommended by any national health organization in the U.S.

Sunburn

Most, if not all, skin diseases are caused by overexposure to the sun. If the sun does not cause them, many of them are made worse by exposure to the sun’s ultraviolet (UV) rays. However, there are benefits to sun exposure, particularly in the case of UV rays, which help the body produce vitamin D that older adults often lack.

The key is to minimize your sun exposure and take efforts to protect yourself at all times. Of course, the most immediate, short-term problem caused by the sun is sunburn. According to the National Institutes of Health (NIH), sunburn occurs when the amount of exposure to UV rays, whether from the sun or from artificial sources, exceeds the body’s ability to produce melanin. Melanin is a protective pigment responsible for tanning, and a suntan is the body’s way of shielding itself against UV rays.

Four Hours After Exposure

Older adults and young children are more susceptible to sunburn than young and middle-aged adults. However, a study of more than 100,000 nurses found that those who had at least five blistering sunburns between the ages of 15 and 20 had an 80 percent higher risk for melanoma, and a 68 percent greater risk of basal cell carcinoma and squamous cell carcinoma.

Not everyone reacts to the sun the same way. It often depends on skin type, length of exposure, time of day and year, geography, and drugs that person is taking.

Which Skin Type Are You?

Of the many factors associated with sunburn, one of the most important is skin type. Several organizations, including the Skin Cancer Foundation, classify skin types from light to dark.

Box 3-17, “Skin Types,” describes the six skin types, their colors and tones, and how they often react to the sun’s rays. However, a JAMA Dermatology study found that dermatologists are more accurate in determining skin types III through VI.

The closer you are to Type I on the scale, the greater your risk of sunburn now and skin cancer later. The darker your skin, the more pigmentation it has to protect itself against the sun.

How Long Does It Take?

A Type I or Type II person can get a sunburn in as little as 15 minutes, while a person with darker skin may be able to tolerate the same amount of exposure for several hours.

When Am I at Highest Risk?

The highest risk for sunburn is between 10 a.m. and 4 p.m., and exposure during the summer months is most dangerous.

Higher-Risk Locations

Drugs That Increase the Risk

Several drugs increase your sensitivity to sunlight and the risk of being burned. Among them are ibuprofen (Motrin, Advil), sulfa antibiotics (Gantanol), doxycycline (Adoxa, Monodox), tetracycline (Periostat, Vibramycin), and diuretics (Diuril, Edecrin).

No Quick Cure

There is no quick cure for sunburns. Aspirin, acetaminophen, and ibuprofen relieve pain and reduce fever. Drink plenty of water to replace lost fluids. Cool baths and wet cloths might feel good, as will moisturizing creams. A low-dose (0.5 to 1 percent) hydrocortisone cream might reduce the burning sensation and hasten the healing process.

If blisters develop, cover the area with a light bandage or gauze. Breaking the blisters will increase the possibility of infection, so allow them to resolve on their own.

Five Ways to Reduce the Risk

Sunscreen makes a significant difference in how rays penetrate skin (see Box 3-18 “UV Penetration into the Layers of Skin”).

Here are five sunburn prevention tips provided by the CDC and NIH:

Use a full-spectrum sunscreen of 30 to 50 SPF.
Apply sunscreen 20 minutes before being exposed to the sun, and reapply every two hours—sooner if you are in and out of water, or if you perspire heavily.
Wear dark clothing with a tight weave to block UV rays.
Wear a wide-brimmed hat that protects the scalp, face, ears, and neck.
Avoid tanning beds.

No Guarantees

Check the UV Index

Before you venture outside, always check the UV index provided by the Environmental Protection Agency (epa.gov/enviro/uv-index-search), in newspapers, or on television weather reports. The index ranges from a low of one to a high of 11. Take extra precautions when the index is six to seven or higher (see Box 3-21, “UV Index Risk Level,” on page 47).

Look for Your Shadow

Slip, Slop, Slap, Seek, Slide

Vitiligo

In vitiligo, the skin loses its color and white patches develop because the melanin cells are destroyed. The condition, which affects 1 percent of the population, can occur anywhere on the body, including skin, hair, scalp, eyebrows and eyelashes, and beard.

Treatable

The drug tofacitinib, normally used to treat rheumatoid arthritis, may be effective to restore skin color to vitiligo patients. It is implanted under the skin to promote the growth of melanocytes.

Warts

Small Risk of Transmission

How to Remove Them

Wounds (minor)

Minor abrasions (scrapes) and lacerations (cuts) damage cells in the epidermis and sometimes beyond, causing them to lose their function, at least temporarily.

As common as cuts and scrapes are, the literature is not consistent on how they should be treated. Washing a wound with soap and water versus washing a wound with water only is one example. Nevertheless, there are some first aid measures accepted by most doctors and wound care experts.

Wash your hands for 15 seconds, and dry them with a clean cloth.
Stop bleeding by pressing a clean paper towel or cloth against the wound for several minutes.
After the bleeding has stopped, rinse the wound with lots of clean water.
Do not use peroxide, iodine solutions, alcohol, or soap in the wound. Some experts say to clean the area around the wound with soap and water.
Gently remove any dirt with a clean, moist cloth.
Apply a non-stick bandage.
Wounds heal best if not too wet, not too dry.

Problem Wounds

More serious wounds require professional care. The American Association for the Advancement of Wound Care says to get help if:

You cannot stop the bleeding.
The wound is deep or has jagged edges.
You have not had a tetanus shot in the past five years.
There is something in the wound that will not easily rinse out.
The wound becomes infected.
The wound will not heal.

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Diabetes Symptoms in Men

Helen Boehm Johnson, MD — Wed, 19 Jul 2017 14:00:39 +0000

Diabetes symptoms in men can mirror diabetes symptoms in women, but there are some differences, as we discuss here. It helps to first understand what diabetes is: a condition characterized by elevated blood glucose levels, which can lead to a number of serious complications.

In people without diabetes, the pancreas produces the hormone insulin, which acts on the body’s cells, moving “sugar,” or glucose, from the blood into the cells, where it can be used for energy.

In type 1 diabetes, the body’s immune system attacks and destroys the cells in the pancreas that produce the hormone insulin resulting in an insulin deficiency and therefore elevated blood glucose levels.
In type 2 diabetes, the cells of the body become resistant to the effects of insulin and the pancreas cannot produce enough extra insulin to compensate for this resistance, resulting in high blood glucose levels.

According to the American Diabetes Association, studies have demonstrated that men are more likely to develop type 2 diabetes symptoms than women, although the reasons for this are unclear.

Men share many of the same risk factors for diabetes as women, including family history, the presence of autoantibodies, living in a colder climate, and possibly exposure to certain viral illnesses for type 1 diabetes and obesity or excess weight, older age, family history, race, sedentary lifestyle, high blood pressure, and abnormal cholesterol levels.

In addition, some researchers believe that diabetes symptoms in men increase with low testosterone levels, which increases the risk for developing insulin resistance or type 2 diabetes. Other scientists think low testosterone is a complication of type 2 diabetes. Either way, there is a definite link between the two with research demonstrating that men with type 2 diabetes are twice as likely to have low testosterone levels as men without diabetes.

Diabetes Symptoms in Men

While men experience many of the classic signs of diabetes that women experience such as increased thirst, increased urination, fatigue, and blurred vision, there are some diabetes symptoms in men that are unique.

Erectile Dysfunction (ED): Men with diabetes are 2 to 3 times more likely to experience impotence or erectile dysfunction than men without diabetes. There is some evidence that suggests ED may be an early sign of diabetes in men 45 years old and younger. There are two possible causes of ED in men with diabetes. The body’s response to sexual stimuli is involuntary and mediated by nerves that are called autonomic nerves. Diabetes can damage these nerves leading to ED. Additionally, diabetes can also damage the blood vessels that allow an erection to occur resulting in ED. It is important to note that there are other causes of ED including some medications, high blood pressure, and cardiovascular disease. If you have diabetes and develop ED, you should consult with your healthcare provider to determine the cause.
Retrograde ejaculation: In retrograde ejaculation some or all of a man’s semen enters the bladder instead of being released from the tip of the penis. This is caused by nerve damage that affects the internal muscles, also called sphincters, that normally prevent semen from entering the bladder. Retrograde ejaculation does not affect orgasm, but may cause fertility problems.
Recurrent genital thrush: Elevated blood sugar levels can lead to increased yeast infections of the penis, resulting in redness, swelling, itchiness, and discharge around the head of the penis.
Reduced lean muscle mass: Men with diabetes may experience a loss of lean muscle mass. This is particularly true for men with diabetes who also have low testosterone levels.

Metabolic syndrome–characterized by a pear-shaped or apple-shaped body type–is an early warning sign of pre-diabetes and diabetes.

Complications in Men with Diabetes

Men can suffer from many of the same complications of diabetes as women including heart disease, nerve damage or neuropathy, eye damage, kidney damage, and foot problems. Some studies have demonstrated that men with diabetes suffer from the complications of stroke and kidney disease more than women, but other studies have not demonstrated this. Men can also experience additional complications:

Infertility: Men who suffer from retrograde ejaculation may have problems with fertility.
Reduced libido: Men who suffer from low testosterone or erectile dysfunction may experience diminished interest in sex.

What Can Men Do to Avoid Diabetes Complications?

All people with diabetes are encouraged to maximize control of their blood glucose levels, adopt a healthy, balanced diet, increase their physical activity, and maintain a healthy weight to increase their odds of avoiding diabetes complications. In addition, men should consult with their urologist to discuss treatment options for symptoms like ED which can include medications, the use of pumps, and even surgery.

Men with retrograde ejaculation wishing to father a child can seek help from a urologist specializing in fertility issues who may be able to collect sperm from urine and utilize it for artificial insemination. Low testosterone levels can easily be treated with hormone injections, patches, or gels.

Knowing what causes diabetes, following your healthcare provider’s recommendations for diabetes management, understanding the signs of complications, and listening to your body so that you can identify symptoms of diabetes are all valuable steps any man with diabetes should take.

WHAT YOU CAN DO

DIABETES DIET TIPS

Diet is critical in managing diabetes in men as well as women. To follow a diabetic diet, make sure your grocery list includes the following:

A variety of fresh vegetables, frozen vegetables not packaged in sauce, or low-sodium/sodium-free canned vegetables. Non-starchy vegetables—such as dark green leafy vegetables, asparagus, broccoli, Brussels sprouts, cauliflower, cucumbers, peppers, and salad greens, are especially important. Limit starchy vegetables (potatoes, green peas, corn, and acorn, butternut squash_.

Fresh or frozen whole fruit instead of fruit canned with added sugar or syrup.

Whole grains. Instead of white bread or tortillas made from refined flour, opt for whole-grain bread or tortillas. Also, avoid notoriously sugar-full cereals and choose whole-grain cereals instead. And instead of regular “white” pasta and white rice, choose whole grain pasta and brown or wild rice. Other worthy grain options include whole oats/oatmeal, bulgur, quinoa, whole-grain barley, buckwheat, millet, and sorghum.

Choose 100 percent fruit juice instead of sugary fruit drinks or punches.

Limit or avoid sweets—candy, doughnuts, cakes, and other processed baked goods add empty calories while providing little in the way of nutrition.

Originally published in May 2016 and updated.

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Diabetes Symptoms: Do You Have Risk Factors?

Helen Boehm Johnson, MD — Mon, 31 Oct 2016 04:01:22 +0000

Scientists have identified a number of risk factors for the development of diabetes. While some of these, such as family history, are the same for all three types of diabetes, there are risk factors unique to each type. Being aware of the risk factors that apply to you can aid both in disease screening and prevention, and help you avoid diabetes symptoms.

Type 1

Family history: Having a sibling or parent with type 1 diabetes increases your risk of developing the disease.

Environmental triggers: While all environmental factors that influence the development of type 1 diabetes and produce diabetes symptoms are not known, scientists have identified several potential triggers. Type I diabetes develops more often during the winter and in places with colder climates, suggesting that cold weather might be a trigger. Additionally, evidence suggests that certain viral infections might also influence the development of type 1 diabetes in some people. In particular, an association between enteroviral infections and type 1 diabetes development has been observed. Studies have demonstrated that in some individuals, infection with a specific group of viruses called enteroviruses has some affect both on the initiation of islet cell autoimmunity (the immune system attacking the groups of cells in the pancreas that produce insulin) and the progression to full-blown type 1 diabetes. More research, however, is needed to determine how enteroviruses cause this effect and why it occurs in some individuals and not others.

Diabetic diet: While the scientific community has not reached a consensus on the link between diet and type 1 diabetes, some researchers have noted an association between type 1 diabetes symptoms and development and early exposure to cow’s milk in some children. Other research has shown an association between low levels of vitamin D and increased risk of type 1 diabetes.

Autoantibodies: Doctors can test for the presence of certain immune cells that are associated with an increased risk of developing type 1 diabetes. While testing positive for these autoantibodies does not guarantee the development of type 1 diabetes, it is generally agreed that the higher the number of autoantibodies an individual has, the greater their risk of developing type 1 diabetes. This is true both in the general population and in those with a family history of type 1 diabetes.

Type 2

Family history: Having a parent or sibling with type 2 diabetes increases your risk of developing the disease.

Obesity: Obesity or increased weight is one of the strongest risk factors for development of type 2 diabetes. Having higher quantities of fatty tissue increases the resistance of the body’s cells to insulin.

Sedentary lifestyle: Exercise helps the body use glucose and increases cells’ sensitivity to insulin. Additionally, exercise helps control weight. Lack of exercise or physical activity therefore increases your risk of weight gain, higher glucose levels, and insulin resistance.

Ethnic background: Type 2 diabetes is more common in African-Americans, Hispanics, Native Americans, Alaskan natives, Asian-Americans, and Pacific Islanders. The reasons for this increased risk are not yet understood.

Age: The risk of developing type 2 diabetes increases as you age, particularly after the age of 45. This may be due to the tendency to have a less active lifestyle as you age and the weight gain that subsequently occurs.

Diet: Research has suggested that a diet high in saturated fats might be a risk factor for type 2 diabetes. Look for foods that lower blood sugar, such as cinnamon, garlic, and blueberries.

Lipid levels: Having low high-density lipoprotein cholesterol (HDL) levels (usually below 35 mg/dl) and/or high triglyceride levels (usually above 250 mg/dl) has been associated with an increased risk of type 2 diabetes.

Gestational diabetes: A history of having had gestational diabetes during a pregnancy or having had a baby weighing over nine pounds increases your risk of developing type 2 diabetes later in life. Some statistics suggest that women who have had gestational diabetes have a 60 percent chance of developing type 2 diabetes within the following 10 to 20 years.

Polycystic ovary syndrome: Among signs of diabetes in women, this syndrome is characterized by, among other traits, abnormal menstrual cycles, increased facial hair, acne, and weight gain. It is a well-known risk factor for type 2 diabetes.

High blood pressure/hypertension: A blood pressure over 140/90 mm Hg is a risk factor for developing diabetes symptoms and type 2 diabetes.

Smoking: Smokers are 30-40 percent more likely to develop type 2 diabetes than non-smokers.

Gestational Diabetes

Weight: Obesity or being overweight increases the risk of developing gestational diabetes during pregnancy

Age: The chances of developing gestational diabetes increase with increasing age.

Family history: Having a sibling or parent with type 2 diabetes increases your risk of gestational diabetes.

Personal history: A history of prediabetes, gestational diabetes with a past pregnancy, or a prior pregnancy resulting in a baby weighing over nine pounds are all associated with an increased risk of gestational diabetes.

Ethnic background: African-American, Hispanic, Native American, and Asian-American women have a higher risk of gestational diabetes.

Originally published in April 2016 and updated.

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Signs of Diabetes: What the Symptoms Mean

Helen Boehm Johnson, MD — Fri, 24 Jun 2016 23:32:16 +0000

Many of the same symptoms can be seen in people with type 1, type 2, and gestational diabetes; however, people with type 1 diabetes tend to have more severe and more sudden-onset symptoms. Conversely, some people with type 2 symptoms may have few or no signs of diabetes, particularly in the early stages of the disease.

Frequent urination

Increased thirst

Increased hunger

Fatigue

Blurry vision

Slow-healing cuts or bruises

Increased infections, particularly skin, vaginal, or gum infections

Dry skin

Patients with type 1 diabetes may additionally experience weight loss, despite having an increased appetite and eating more.

Patients with type 2 diabetes may develop a velvety darkening of the skin on the back of their necks and in their armpits, called acanthosis nigrans. Type 2 diabetics may also experience numbness or tingling in their hands or feet.

If you are experiencing any of the classic signs of diabetes, your doctor or healthcare provider will order a diabetes test. However, since some people with type 2 diabetes do not experience any signs of diabetes initially, the American Diabetes Association (ADA) has recommended that all people over the age of 45 have their blood glucose level tested every three years.

Testing Info

The ADA also recommends that any person who has a body mass index (BMI) of 25 and at least one additional risk factor (family history, low HDL cholesterol, high triglycerides, smoking, African-American/Asian-American/Native American/Hispanic ethnicity, sedentary lifestyle, polycystic ovarian disease, history of gestational diabetes, high blood pressure, etc.) be screened. Tests typically used:

A1C Test: When glucose is in the blood, it attaches to the oxygen-carrying substance, hemoglobin, forming what scientists call “glycated hemoglobin.” The percentage of glycated hemoglobin or percentage of hemoglobin with blood glucose attached can be measure by the A1C test and that amount reflects your average blood glucose over the past two to three months.

The higher your blood glucose levels have been, the higher your A1C will be. An A1C less than 5.7 percent is normal. An A1C between 5.7 and 6.4 percent likely means you will be diagnosed with pre-diabetes, a disease of insulin resistance resulting in blood glucose levels that are elevated but not high enough to be considered diabetes. An A1C of 6.5% or higher means you have diabetes.

Random Plasma Glucose Test: This is a blood/plasma test administered any time of the day , regardless of when you last ate, measuring your level of glucose. Diabetes is diagnosed with any random blood glucose result of 200 milligrams per deciliter (mg/dl) or higher.

Fasting Plasma Glucose Test (FPGT): Just as the name applies, this is a blood/plasma test administered when you have been fasting (for at least 8 hours), measuring your level of glucose. A fasting blood glucose test less than 100mg/dl is considered normal. A fasting blood glucose level between 100 and 125mg/dl is considered to be prediabetes. A fasting blood glucose level of 126 mg/dl or higher means you have diabetes.

Oral Glucose Tolerance Test (OGTT): This test involves fasting for eight hours after which your blood glucose level is measured. You then drink a special solution containing 75 grams of glucose and your blood glucose level is measured again two hours later. This test can be used for all forms of diabetes and has been shown to be more sensitive than the FPGT; however, it is more time consuming and, thus, less convenient. This is the primary test obstetricians use for testing pregnant women for gestational diabetes and is typically administered between the 24th and 28th week of pregnancy. In some cases, an obstetrician will first administer a glucose challenge test where the mother will drink a glucose solution and have her glucose level checked one hour later. If it is abnormal, she will then be scheduled for an OGTT.

A two-hour blood glucose level less than 140mg/dl is normal. An individual is diagnosed with prediabetes if their two-hour blood glucose level is between 140 and 199 mg/dl. Diabetes is diagnosed when the two-hour blood glucose level is 200 mg/dl or higher.

Originally published May 2016.

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